Ureteral access sheath use for retrograde intrarenal surgery should involve systematic visual assessment of the entire ureter to recognize severe ureteral injury. The incidence of severe ureteral injury is largely decreased by preoperative Double-J stenting.

Ingestion of 2 gm AA daily results in no change in urinary pH but a moderate though statistically significant increase in urinary oxalate in NS (20%) and SF (33%). Stone formers respond no differently to AA than normal subjects. We recommend limiting AA use to less than 2 gm daily in CaOx stone formers.

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In vivo experience enables urological surgeons inexperienced with laparoscopy to improve significantly in all aspects of complex laparoscopic procedures. In this pilot study the magnitude of improvement was independent of additional training in laparoscopic skills. Educational curriculum should include in vivo practice in addition to skills training.

SummaryBackground and objectives Bone demineralization is frequent in renal-stone formers with hypercalciuria. Although this pathologic link has been recognized for decades, the underlying mechanisms and risk factors associated with osteopenia/osteoporosis in this population remain partially understood.Design, setting, participants, & measurements This study retrospectively analyzed determinants of low bone mineral density (BMD) in 65 idiopathic hypercalciuric male renal-stone formers. Clinical and biologic evaluation included BMD measurement, bone-remodeling markers, analysis of calcium metabolism with oral calcium load test, and dietary inquiry.Results Patients with osteopenia (n ϭ 23, 35% of the population) presented significantly higher fasting calciuria as compared with normal bone density patients (n ϭ 42) (calcium/creatinine ratio was 0.32 versus 0.24 mmol/mmol; P ϭ 0.006). Analysis of the whole population revealed a negative association between fasting hypercalciuria and BMD (P ϭ 0.003), independent of confounding variables including body-mass index and tobacco consumption. The fasting calcium/creatinine ratio above 0.25 mmol/mmol was associated with a 3.8-fold increase in the risk of low BMD. ConclusionIn our study, fasting hypercalciuria after a 2-day calcium-restricted diet appears as the only biologic factor associated with low BMD, suggesting a bone-calcium efflux. Our results support the view of a parathyroid-independent pathologic process that remains to be identified. Hypercalciuric patients with low BMD do not excrete more calcium in 24-hour urine samples than patients without low BMD.