The Urological Association of Asia, consisting of 25 member associations and one affiliated member since its foundation in 1990, has planned to develop Asian guidelines for all urological fields. The field of stone diseases is the third of its guideline projects. Because of the different climates, and social, economic and ethnic environments, the clinical practice for urinary stone diseases widely varies among the Asian countries. The committee members of the Urological Association of Asia on the clinical guidelines for urinary stone disease carried out a surveillance study to better understand the diversity of the treatment strategy among different regions and subsequent systematic literature review through PubMed and MEDLINE database between 1966 and 2017. Levels of evidence and grades of recommendation for each management were decided according to the relevant strategy. Each clinical question and answer were thoroughly reviewed and discussed by all committee members and their colleagues, with suggestions from expert representatives of the American Urological Association and European Association of Urology. However, we focused on the pragmatic care of patients and our own evidence throughout Asia, which included recent surgical trends, such as miniaturized percutaneous nephrolithotomy and endoscopic combined intrarenal surgery. This guideline covers all fields of stone diseases, from etiology to recurrence prevention. Here, we present a short summary of the first version of the guideline – consisting 43 clinical questions – and overview its key practical issues.

The effect of urinary tract infection (UTI) on mucosal damage and production of proteins promoting urinary stone formation has not been elucidated. Osteopontin production, with associated mucosal damage due to UTI, may allow easier crystal retention and nucleation resulting in stone formation. The aim of this study is to demonstrate that expression of osteopontin (OPN), OPN mRNA, TLR-4, JNK, TNFR-1, iNOS, HMGB-1, and apoptosis process is higher than normal at renal tubular cells due to urinary tract infection by Escherichia coli. Adult male New Zealand strain rabbits were used. Thirty New Zealand strain rabbits were divided into three groups. The first group acted as controls, the second group underwent ligation of right ureter, and the third group underwent ligation of right ureter and injection of Escherichia coli 105/ml proximal to ligation. Nephrectomy and histological examination were performed after 5 days. All groups were HE stained to examine mucosal damage, specific monoclonal antibodies for TLR-4, JNK, mRNA OPN, OPN, TNFR-1, iNOS and HMGB-1. Apoptotic nuclei were demonstrated using TUNEL method. Statistical calculations were performed using ANOVA test, with p < 0.05 considered significant. The findings confirmed the hypothesis that infection of urinary tract by Escherichia coli demonstrated higher expression of OPN, OPN mRNA, TLR-4, JNK, TNFR-1, iNOS, HMGB-1, apoptosis process and mucosal damage than normal. Infection of urinary tract by Escherichia coli caused higher than normal expression of promoter protein osteopontin and mucosal damage at renal tubular cells. These suggest that urinary infection may promote stone formation by mucosal damage and elevate promoter protein osteopontin at tubulus cell, allowing easier crystal retention and nucleation.

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Objectives: To study rate of urethrocutaneous fistula formation associated with usage of indwelling urethral catheter compared to suprapubic catheter with stent after hypospadias repair. Materials and methods: Twenty patients with primary hypospadias of penile shaft and posterior type underwent reconstruction with onlay technique by a single operator. Urinary diversion in 10 patients utilised a urethral catheter, while the remainder used a silicone suprapubic catheter with stent. Results: Seven urethrocutaneous fistula were observed (35%) with 4 fistulas in the group with suprapubic catheter and stent, and 3 fistulas in the group with urethral catheters. Fisher exact test value was 0,001 with significance level of 1,000 (p>0,05). Conclusion: There was no difference in rate of urethrocutaneous fistula with use of urethral catheter and suprapubic catheterisation with stent after hypospadias repair.

Objective:  To compare the successful of the identification of the ureteral orifice at cervical cancer patients who received phenazopyridine orally and to analyze the correlation between hydronephrosis and successful rate for retrograde stenting. Material & Method: This was a comparative experimental study, using phenazopyridine hcl orally prior to cystoscopy to identify the ureteral orifice on cervical cancer patients and to perform retrograde stenting on spotted ureteral orifice. Forty samples provided consent to enroll in this study. Mean age was 49.2 ± 5.16 years. Thirty-four out of 40 samples was confirmed as squamous cell carcinoma type. Results: Chi-square test demonstrated no significant differentiation in finding ureteral orifice between treatment and control group on stage 3B (p = 0.408). However, result shown conversely on stage 4A (p = 0.046). There was no significant disparity in conducting retrograde stenting between treatment and control group on stage 2B and 3B (p = 0.221 and p = 0.197). There was no significant correlation between hydronephrosis gradation and retrograde stenting on control group (p = 0.144). Conclusion: Administration of phenazopyridine HCL orally in cervical cancer patients increase success for ureteral orifice identification and retrograde stenting, but not statistically significant. There is no correlation between hydronephrosis with a success retrograde stenting.Keywords: Cervical cancer, hydronephrosis, phenazopyridine hcl, ureteral orifice, retrograde stenting.