This case report describes a 52-year-old patient presenting with recurrent episodes of pancreatitis and renal stones. Further investigation revealed hypocalcemia and elevated parathyroid hormone (PTH) levels, leading to diagnosis of a parathyroid adenoma. This case highlights the importance of considering primary hyperparathyroidism in patients with recurrent pancreatitis and renal stones, as early diagnosis and surgical intervention can prevent recurrence and reduce morbidity.
UNASSIGNED: Primary Hyperparathyroidism secondary to Parathyroid adenoma, rarely presents as acute pancreatitis. A 38-year-young male with a history of recurrent renal stones referred from a local center, presented to the emergency services, with a diagnosis of acute pancreatitis and bilateral renal stones. Laboratory evaluation showed an elevated calcium level, elevated PTH levels, low vitamin D, and low phosphorus levels. CT scan done outside was suggestive of acute pancreatitis along with bilateral renal calculi. USG neck and MIBI scan done as a part of hypercalcemia evaluation showed presence of a right parathyroid adenoma. Parathyroid adenoma was later removed, and calcium and parathyroid levels were normal on subsequent follow ups.

Nephrolithiasis, a common urological disease, could indicate a more ominous pathology beyond the kidneys. Patients who present with renal stones must be investigated for serum calcium and subsequently parathyroid hormones, if indicated, as one of the clinical presentations of primary hyperparathyroidism is renal stones.
UNASSIGNED: A 48-year-old married female with a past medical history significant for renal stones presented to the clinic chiefly complaining of muscle pain, joint pain, and fatigue. After thorough investigations, she was diagnosed with a case of primary hyperparathyroidism due to parathyroid adenoma and was managed surgically according to guidelines.
UNASSIGNED: Hypercalcemia, serum calcium of greater than 2 standard deviations above the reference value, is commonly seen to be associated with parathyroid mass therefore, assessment of serum calcium is a necessary step toward the diagnosis of parathyroid adenoma in cases with recurrent renal stones.
UNASSIGNED: Recurrent nephrolithiasis requires more thorough investigation for the possible underlying cause. Primary hyperparathyroidism due to parathyroid adenoma can present with recurrent renal stones and some vague symptoms.

Nephrolithiasis represents a common cause of non-obstetrical abdominal pain during pregnancy with 1 out of 200 pregnancies being affected. 20%-30% of patients require ureteroscopy. Many studies were done on safety of holmium:yttrium-aluminium-garnet (YAG) during pregnancy but none on Thulium Fiber Laser (TFL). To our knowledge, this is the first reported case of pregnant patient with nephrolithiasis that was treated using ureteroscopy and TFL. We present a 28 years old pregnant woman that presented to our hospital with a left distal ureteric stone. Patient underwent URS and lithotripsy using TFL. The procedure was tolerated with no complications.

UNASSIGNED: The tubeless percutaneous nephrolithotomy (PCNL) was proposed to eliminate the side effects of the nephrostomy tube in recent years, such as pain, channel infection, postoperative bleeding, and longer hospital stay. But there is neither clinical guidelines nor consensus about tubeless PCNL in clinical practice. The study is aimed to how to implement the tubeless PCNL step by step, including case selection preoperatively, improving the technique of the surgeon, making the correct decisions at the end of the procedure, which had not been previously examined.
UNASSIGNED: From January 2017 to March 2018, 364 consecutive patients requiring PCNL were comprehensively analyzed preoperatively and patients were selected for scheduled tubeless PCNL based on four aspects. The selected patients were divided into two groups according to whether the nephrostomy tube was finally placed. The mean operative time, intraoperative blood loss, stone clearance rate, visual pain score, postoperative hospitalization days and perioperative complications were all evaluated.
UNASSIGNED: Based on the preoperative evaluation, 42 patients were selected for tubeless PCNL, among which there were finally 37 cases of completed tubeless PCNL. Compared with patients undergoing conventional PCNL, there were not statistical differences in the mean operative time (P=0.207) or intraoperative blood loss (P=0.450) in the tubeless group. Stone clearance rate was 100% in both groups. The visual pain scores in the tubeless PCNL group were lower on operation day (P=0.029), first postoperative day (P<0.001) and the day of discharge (P=0.025). The postoperative hospitalization for the tubeless PCNL group was shorter than that of the control group (P<0.001). No significant difference in grade 1 complications was seen (P=0.424), and no grade 2 or higher complications were observed in either group.
UNASSIGNED: Postoperative pain was significantly relieved and postoperative hospitalization was significantly shortened in the tubeless PCNL group. Tubeless PCNL is safe if patients are carefully selected using four criteria before operation, attention is paid to four key points and five confirmations are made during operation.

A 13-year-old patient presented to the emergency department with a history of abdominal pain and right flank pain. Two days before, she was evaluated at her pediatrician\'s office and was diagnosed with acute gastroenteritis and sent home. In the emergency department, the patient was diagnosed with ureterolithiasis after a physical examination, laboratory work, and imaging findings. She was treated successfully with conservative medical management. Symptomatic presentation of ureterolithiasis can include abdominal pain, flank pain, hematuria, dysuria, urgency, nausea, and vomiting. Nurse practitioners need to recognize nonspecific symptoms of ureterolithiasis for accurate diagnosis and treatment. Risk factors, signs and symptoms, prevention, and treatment options for ureterolithiasis are discussed.

Renal ectopia with stone is a rare case with no specific reported incidence rate. The treatment of kidney stone in ectopic kidneys poses a challenge to urologists. A 48-year-old male presenting with colicky pain on the right flank since one year ago. CT urography revealed an right-crossed renal ectopia and hyperdense lesions (25 × 20 mm and 10 × 10 mm) in the ureteropelvic junction of the right kidney. Under general anesthesia, we performed open pyelolithotomy for the patient and removed two stones completely. Open surgery could be the choice for patients with complex stone burden and associated renal anomalies such as ectopic kidney.

Multiple endocrine neoplasia type 1 (MEN1) is a complex, autosomal dominant inherited syndrome characterized by 3 different tumors (parathyroid, anterior pituitary, and pancreatic islet). The diagnosis is defined clinically by the presence of 2 or more primary tumors. We report the case of a 35 years old patient who presented with recurrent renal stones and imaging findings for MEN1. Computed tomography pancreas revealed a mass in the tail which was confirmed by magnetic resonance imaging. Ultrasound of her neck showed a mass on the left side and MIBI scan diagnosed a parathyroid adenoma which was later pathologically confirmed.

Gas-containing stones are extremely rare. The formation of renal stones, including the presence of free gas within the stone, is overall poorly understood. The presence of free gas in the collecting system of the urinary tract indicates emphysematous pyelonephritis, in the absence of prior surgical intervention, gastrointestinal fistula, or urinary bladder catheterization. Here, we present the tenth case of gas-containing renal stones, as detected by computed tomography, and discuss the main diagnostic features to differentiate gas-containing stones from emphysematous pyelonephritis.

A few cases associating high dose intravenous vitamin C (IVC) administration with renal stone formation have been reported in the literature, however, no long-term studies investigating IVC administration and reported renal stones have been carried out. Our aim was to measure the frequency of reported renal stones in patients receiving IVC therapy. We carried out a prospective case series study of 157 adult patients who commenced IVC therapy at Integrated Health Options clinic between 1 September 2011 and 31 August 2012, with follow-up for 12 months. Inquiries into the occurrence of renal stones were conducted at enrolment, 6 and 12 months, and renal function blood tests were conducted at enrolment, 4 weeks and every 12 weeks thereafter in a subgroup of patients. No renal stones were reported by any patients in the study, despite 8% of the patients having a history of renal stones. In addition, the majority of patients investigated had stable renal function during the study period as evidenced by little change in serum creatinine levels and estimated glomerular filtration rate (eGFR) following IVC. In conclusion, IVC therapy was not associated with patient-reported renal stones. Although not the primary focus of this study, it was also observed that there was no significant change in mean serum creatinine or eGFR for those who had follow-up renal function blood tests.

BACKGROUND: Studies on outcomes and risk factors for neonatal nephrocalcinosis (NC) and renal calculi (RC) are limited, and often do not include controls for comparison. We conducted a case-control analysis to identify risk factors associated with NC and/or RC in neonates and studied the natural course of these anomalies.
METHODS: Infants diagnosed with NC/RC on ultrasound within the first year of life and corresponding gestational age- and gender-matched controls were identified from the neonatal intensive care unit database at our institution over a 10-year period. Risk factors assessed included: low birth weight, small for gestational age, nephrotoxic drugs, respiratory support therapy, use of total parental nutrition (TPN), surgeries, history of UTIs, creatinine at presentation, and history of maternal hypertension. Unadjusted odds ratios were estimated. Chi square analysis was performed for binary variables and the Mann-Whitney U test for continuous variables. Outcomes examined include time to resolution of NC/RC, renal function, and hypertension.
RESULTS: We identified 22 cases of NC/RC with corresponding matched controls. Median follow-up was 28 months (IQR 0-122 months). History of urinary tract infections (UTI) was the only variable significantly associated with the presence of NC/RC (OR 5.62, 95% CI 1.12-31.1, p < 0.013) (Table). All other known risk factors were comparable in both groups. There was no difference in the incidence of hypertension (OR 2.94, 95% CI 0.40-33.82, p = 0.216) at diagnosis or last follow-up between the groups. Resolution of NC/RC was observed in 72.7%, during a median follow-up of 12.1 months. Mean urinary calcium/creatinine ratio for the NC/RC group was 2.3 ± 1.5 at diagnosis and 0.96 ± 0.8 at last follow-up.
CONCLUSIONS: Most NC/RC in infants resolve without surgical intervention but some infants require medical therapy and follow-up. Risk factors for NC/RC in neonates continue to be poorly defined because of the quality of studies available. Our study provides further adjustment for confounders but has a small sample size and is restricted to neonates from an intensive care unit.
CONCLUSIONS: Most cases of NC/RC resolve spontaneously without surgical intervention. The mean time to resolution is 12.1 months, without untoward consequences in terms of hypertension. A history of UTIs is the only identified risk factor identified in this study which is associated with a significant increased risk of neonatal nephrocalcinosis and/or renal calculi. Larger prospective studies are warranted to confirm these findings.