Purpose: To compare the outcomes and complications of supine X-ray-free ultrasound-guided percutaneous nephrolithotomy (XG-PCNL) with fluoroscopy-guided (FG)-PCNL in both prone and supine positions. Methods: This was a comparative study that included a prospective cohort and historical control groups. This study analysed 40 consecutive patients who undergone supine XG-PCNL between October 2019 and March 2020. The control groups were composed of historical control formed from the last 40 consecutive patients who underwent FG-PCNL in both supine and prone positions from our PCNL database from January 2018 and September 2019. Patients’ demographics, stone characteristics and intraoperative and postoperative outcomes were compared. Results: A total of 120 patients were classified into the supine XG-PCNL, supine FG-PCNL, and prone FG-PCNL groups (each N = 40). They had similar baseline characteristics and initial stone burden. The supine XG-PCNL group had higher puncture attempts, nephrostomy tube placement, and longer surgery duration than both the supine and prone FG-PCNL groups. However, the stone-free rate was similar in all groups (85%, supine XG-PCNL; 72.5%, supine FG-PCNL; 77.5% prone FG-PCNL; p = 0.39). No significant difference was found in the complication rate and length of stay among the three groups. Conclusion: Supine XG-PCNL is an alternative to both supine and prone FG-PCNL with similar efficacy and complication rates for kidney stone patients. This could be a good alternative to urological centres with no access to fluoroscopy.

Urinary tract infection (UTI) is more prevalent in boys with antenatal hydronephrosis (ANH). Circumcision is known to lessen the risk of UTI. This study was performed to examine the associations between circumcision and UTI among patients with ANH. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed for conducting this systematic review and meta-analysis. PubMed, ScienceDirect, EMBASE, and Cochrane Library databases were searched through August 4th, 2022 to identify eligible studies. The risk of bias was measured using the Newcastle-Ottawa Scale (NOS). Review manager 5.4 was used for all analysis. A total of 21 studies involving 8,968 patients with ANH were included in the meta-analysis. The incidences of UTI were 18.1% in the uncircumcised group and 4.9% in the circumcised group. From analysis, circumcision had significant protective effect against UTI with pooled OR of 0.28 (95% CI 0.23-0.32). The significant protective effects were also found in subgroup analysis of hydronephrosis etiology, including vesicoureteral reflux (pooled OR of 0.24; 95% CI 0.17-0.32), obstructive hydronephrosis (pooled OR of 0.34; 95% CI 0.21-0.53), and posterior urethral valve (pooled OR of 0.28; 95% CI 0.16-0.52). Our meta-analysis showed that circumcision was associated with a decreased incidence of UTI in children with ANH. This benefit was consistent irrespective of the underlying cause of hydronephrosis.

Genetic polymorphisms have been suggested as risk factors affecting the occurrence and recurrence of kidney stones, although findings regarding the latter remain inconclusive. We performed this systematic review and meta-analysis to clarify the associations between genetic polymorphisms and recurrent kidney stones. PubMed, SCOPUS, EMBASE, and Cochrane Library databases were searched through May 28^th, 2020 to identify eligible studies. The Quality in prognostic studies (QUIPS) tool was used to evaluate bias risk. Allelic frequencies and different inheritance models were assessed. All analyses were performed using Review manager 5.4. A total of 14 studies were included for meta-analysis, assessing urokinase (ApaL1) and vitamin D receptor (VDR) (ApaI, BsmI, FokI, and TaqI) gene polymorphisms. The ApaLI polymorphism demonstrated protective association in the recessive model [odds ratio (OR) 0.45, P < 0.01] albeit higher risk among Caucasians in the heterozygous model (OR 16.03, P < 0.01). The VDR-ApaI polymorphism showed protective association in the dominant model (OR 0.60, P < 0.01). Among Asians, the VDR-FokI polymorphism recessive model showed significant positive association (OR 1.70, P < 0.01) and the VDR-TaqI polymorphism heterozygous model exhibited protective association (OR 0.72, P < 0.01). The VDR-BsmI polymorphism was not significantly associated with recurrent kidney stones in any model. Urokinase-ApaLI (recessive model), VDR-ApaI (dominant model), and VDR-TaqI (heterozygous model) polymorphisms were associated with decreased recurrent kidney stone risk whereas urokinase-ApaLI (heterozygous model) and VDR-FokI polymorphisms were associated with increased risk among Caucasians and Asians, respectively. These findings will assist in identifying individuals at risk of kidney stone recurrence.

Ureteral stenosis is one of the most common urological complications following kidney transplantations. It is occurred in 2–10% of patients and poses a significant problem to the patients as it may lead to permanent damage to renal damage. Identification of risk factors is important to prevent the incidence of ureteral stenosis. Thus, we aim to determine the risk factors of ureteral stenosis in the Indonesian population. This is a retrospective analysis of 487 kidney transplant patients performed in Cipto Mangunkusumo Hospital between 2014 and 2018. We collected and compared donor and recipient demography data in recipients who developed ureteral stenosis and recipients who did not develop ureteral stenosis. Ureteral stenosis was defined as the presence of hydronephrosis from ultrasound and increased number of serum creatinine. The overall incidence of ureteral stenosis post-kidney transplantation in our center is 6.6% (32 from 487 patients) from January 2014 until June 2018. We found that older donor and recipient age more frequent in developing ureteral stenosis post-kidney transplantation ( p < 0.001). We also found that donors with number of arteries more than 2 ( p < 0.001) and prolonged warm ischemic time ( p < 0.05) are more frequently to develop ureteral stenosis post-kidney transplantation. There is no association between type II diabetes mellitus and hypertension with ureteral stenosis in this study. Donor age, recipient age, donor number of arteries more than 2, and prolonged warm ischemia time are associated with ureteral stenosis after kidney transplantation.

Hypospadias is a prevalent congenital anomaly that requires effective parental education. Current online resources often exceed recommended readability levels, potentially hindering understanding. This study evaluates the utility of ChatGPT in providing accurate, clear, and actionable information towards parental education about hypospadias. A structured set of questions was posed to ChatGPT 4.0 covering diagnosis, treatment options, and postoperative care. Responses were quantitatively assessed using the Patient Education Material Assessment Tool for Printable Materials (PEMAT-P) to measure understandability and actionability. Qualitative evaluations were conducted by six pediatric urologists who rated the information for accuracy on a scale from 1 (completely accurate) to 4 (completely inaccurate). The Fleiss' Kappa statistic was calculated to assess inter-observer agreement among the urologists. The quantitative assessment yielded understandability scores between 84 % and 92 % (average 88 %), while actionability scores ranged from 37 % to 70 % (average 51 %). In the qualitative assessment, 41 % of responses were deemed completely accurate, with 35 % considered accurate but inadequate, and 24 % rated as inaccurate. The overall Kappa value was 0.607, indicating substantial agreement among reviewers regarding the accuracy of the information provided by ChatGPT. ChatGPT can effectively convey information about hypospadias, but enhancing the actionability of its responses is crucial. Inaccuracy is still a main concern in using AI-generated search engine. Future updates should include more accurate and reliable responses and visual aids addition may support parents in navigating their child's care.