Ureteral diverticulum is an exceptionally rare abnormality that may be congenital or acquired secondary to chronic obstruction, calculi, infection, or prior instrumentation. While often asymptomatic, complicated cases can present with hematuria, recurrent UTIs, or sepsis. A 60-year-old bedridden woman with morbid obesity and a history of multiple endourological procedures presented with urosepsis and hematuria. Computed tomography demonstrated mild hydroureteronephrosis and a periureteric fluid collection with gas locules and contrast extravasation, initially raising suspicion of an infected urinoma. Subsequent retrograde pyelography and rigid ureteroscopy confirmed a narrow-necked ureteral diverticulum at the level of the sacroiliac joint. Following antibiotic therapy and urinary drainage, the patient improved clinically and was managed conservatively due to her high operative risk, remaining asymptomatic at follow-up. Acquired ureteral diverticulum should be considered in patients with hematuria, urosepsis, and a history of prior endourological procedures when cross-sectional imaging shows periureteric collections or contrast leakage. Retrograde pyelography and ureteroscopy are essential for distinguishing a diverticulum from free ureteral perforation. Conservative management with urinary drainage is a viable approach in selected high-risk patients.

In our study, we investigated the predictive value of the region of interest (ROI)-modified Mayo Adhesive Probability (MAP) score which objectively assesses perirenal fat density for postoperative fever following retrograde intrarenal surgery (RIRS), as well as its comparative performance against the conventional MAP score. This retrospective study included 318 patients who underwent RIRS with a sterile urine culture between January 2021 and May 2025. Demographic, stone, and procedure-related data were recorded. Both scores were calculated from non-contrast computed tomography (CT) images prior to surgery; independent risk factors for postoperative fever were identified using logistic regression models and compared via receiver operating characteristic (ROC) analysis. Postoperative fever developed in 41 patients (12.9%). In the model including the conventional MAP score, diabetes mellitus (DM) (odds ratio [OR] = 3.475, p = 0.002), recurrent urinary tract infection (UTI) (OR = 3.567, p = 0.039) and MAP ≥ 3 (OR = 2.707, p = 0.006) were identified as independent risk factors. In the model including the ROI-MAP score, DM (OR = 2.953, p = 0.008) and ROI-MAP ≥ 3 (OR = 7.057, p < 0.001) were identified as independent predictors. The ROI-MAP score demonstrated statistically significantly higher predictive accuracy compared to the conventional MAP score (area under the curve [AUC]: 0.789 vs. 0.709; p = 0.011). The ROI-modified MAP score, which reduces interobserver variability through Hounsfield unit (HU)-based measurement of perirenal fat density, may serve as a potentially useful adjunct for identifying patients at risk of fever following RIRS during the preoperative period.

The effectiveness of dietary and pharmacologic stone prevention strategies may be limited by poor patient adherence. This systematic review aims to assess adherence to the American Urological Association (AUA) guidelines for medical management of kidney stone disease by (1) determining how adherence influences clinical outcomes, (2) identifying which preventive interventions demonstrate the highest adherence, and (3) characterizing factors associated with adherence. A systematic review was conducted according to PRISMA guidelines. PubMed, Scopus, and Embase were searched from database inception through January 1, 2026, using terms related to nephrolithiasis and patient adherence/compliance. Studies involving adults with prior kidney stones reporting adherence to dietary, pharmacologic, or metabolic evaluation-based prevention were included. Dual-reviewer screening and standardized data extraction were performed. No protocol was prospectively registered. Of 909 identified studies, 35 met inclusion criteria, comprising 57,970 patients. Across studies, greater adherence consistently correlated with decreased subsequent stone related events. Increased fluid intake demonstrated the highest lifestyle adherence (~ 65-85%), while thiazide diuretics showed the greatest pharmacologic adherence (43-87%), exceeding citrate therapy and dietary modification. Adherence to metabolic evaluation and longitudinal follow-up testing was relatively low. Predictors of improved adherence included older age, higher education and socioeconomic status, prior stone events, and greater disease severity. Traditional physician counseling has a positive relationship on adherence to medical management. Adherence to guideline-based kidney stone prevention strongly influences clinical outcomes. Tailored counseling and prevention plans informed by patient and disease characteristics are critical to improve effectiveness of stone prevention therapy.

The prevalence of urinary stones range between 1 and 14% in different countries around the world. Men account for approximately 67% of cases, but the gender gap is narrowing over time. A study conducted in the Russian Federation showed that 22.2% of subjects interviewed with a questionnaire reported a history of urolithiasis. Stone formation begins with the urinary crystallization of less soluble solutes contained in urine (calcium oxalate and/or calcium phosphate, uric acid, struvite, and cystine), which often depends on urinary pH values. The most common calcium oxalate stones can grow on calcium phosphate plaques (Randall's plaque) that emerge on the surface of the papilla or on calcium oxalate plugs that form in the collecting ducts due to excessive concentrations of calcium or oxalate. Randall's plaques form due to a proinflammatory process initiated by local macrophages with activation of fibroblasts, matrix modeling, and interstitial calcium phosphate deposition. The inhibitory effect of crystallization and crystal aggregation was studied in vitro demonstrating a reduction in the nucleation inhibition index and in aggregation inhibition index in renal stone formers compared to healthy controls (2.15% vs 6.15% and 34.15% vs 62.15%, respectively). Urolithiasis is a cluster of metabolic phenotypes interacting through urinary supersaturation. The metabolic work-up consists in the identification of high-risk patients requiring full metabolic profiling by basic metabolic panel, two 24-hour urine collections, stone analysis (when available), and software assessment of Relative Supersaturation (RSS) for calcium oxalate, calcium phosphate and uric acid. The endpoint of therapy is to reduce RSS not just to achieve "normal" lab values. The most active agents used for the prevention of calcium oxalate stones are phytate, potassium citrate, and magnesium. Phytate stands as the most potent inhibitor of both calcium oxalate and calcium phosphate crystallization exerting its therapeutic effect without modifying urinary pH. It is the ideal inhibitor of calcium oxalate crystallization, particularly in cases of severe hypercalciuria, because it does not increase the risk of secondary calcium phosphate crystallization. Potassium citrate has a weaker direct inhibitory potential at the concentrations achieved in standard clinical practice and tends to increase urinary pH, posing a risk of inducing calcium phosphate precipitation. Magnesium does not affect urinary pH, but its inhibitory effect of calcium oxalate crystallization is negligible at conventional clinical doses [...].

Renal stones remain a prevalent renal disorder characterized by high recurrence rates and limited therapeutic options, encouraging continued research into novel agents capable of treating established stone disease. Camelus dromedarius hump fat has long been used in North African alternative medicine to treat various dermal and inflammatory diseases. This study aims to evaluate the antioxidant activity, specifically radical scavenging, and the therapeutic potential of this fat against Calcium oxalate stones induced by Ethylene glycol in a Wistar rat model. Twenty Wistar rats were divided into four groups (n=5). The first group serves as the control. The three other groups received EG in their drinking water until stones formed. Rats were fed a fresh dromedary hump fat diet at 45% w/w daily. Urinary parameters (volume, pH, electrolytes), serum biochemical assessments, and measured creatinine clearance were analyzed. Renal histopathology was performed to evaluate tissue changes. The EG-treated rats showed significant disturbances in all physiological parameters, including decreases in urinary volume, pH, and urinary electrolyte excretion. DHF demonstrated strong antioxidant activities, with DPPH scavenging (69.158%-85.571%), FRAP values (70.785%-83.971%), and ABTS (59.145%-89.195%), indicating potential to reduce oxidative stress. In addition to that, treatments with the DHF diet significantly increase urinary volume from 6.3 ± 0.2 ml to 10.12 ± 0.1 ml (p < 0.001). These alterations extend to serum creatinine and urea levels. A high increase in serum creatinine and urea levels was shown. The DHF-treated group showed a creatinine clearance of 3.46 ± 0.68 ml/min on day 21. Importantly, the DHF diet protected the liver from EG-induced damage, as evidenced by serum levels of gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and alanine aminotransferase (ALT) that were near control levels. In contrast, the EG-only group exhibited marked elevations in enzyme levels (p < 0.01). These findings suggest that the DHF 45% w/w diet may exert its protective effect by reducing oxidative stress and preserving tubular epithelial integrity, thereby improving urinary electrolyte excretion, decreasing crystal formation, and protecting renal tissue.

Ureteral perforation and avulsion are rare but potentially severe complications of ureteroscopy (URS), and their reported incidence varies substantially because of heterogeneous populations, techniques, and denominators. The objective of presented meta-analysis was to estimate the procedure-level incidence of ureteral perforation and avulsion during URS for ureteral stones and explore study-level factors associated with these complications. This systematic review and meta-analysis followed the PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420261441125). PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library, and Google Scholar were searched on June 1, 2026. Random-effects meta-analyses of proportions used logit transformation and REML estimation. Heterogeneity, prediction intervals, small-study effects, influence diagnostics, subgroup analyses, and exploratory univariable meta-regression were assessed. Risk of bias was evaluated using the JBI Critical Appraisal Checklist for Case Series. Fifteen studies comprising 20,635 ureteroscopic procedures were included. The pooled incidence of ureteral perforation was 1.89% (95% CI 1.11-3.19%; I[2]=93.5%), with a prediction interval of 0.26-12.45%. Perforation incidence was 1.39% in studies not restricted to impacted stones versus 13.71% in impacted-only cohorts. The pooled incidence of ureteral avulsion was 0.32% (42 events; I[2]=64.9%), with a prediction interval of 0.04-2.76%; corresponding subgroup rates were 0.24% and 2.44%, respectively. Among non-impacted-only studies, a higher male proportion was associated with greater study-level odds of perforation (OR 2.03 per 10% increase; 95% CI 1.26-3.26; p = 0.003). Other examined demographic, stone, instrument, and lithotripsy variables were not significantly associated with either outcome; meta-regression findings remain exploratory. Ureteral perforation and avulsion remain uncommon but clinically important URS complications. Impacted stones identify a markedly higher-risk procedural context, supporting risk-stratified, atraumatic ureteroscopic strategies.