Thiruvananthapuram Medical College Principal warns doctors after organ donation controversy

Thiruvananthapuram: A controversy has erupted after the Head of the Nephrology Department at Thiruvananthapuram Medical College Hospital (MCH) publicly criticised Kerala’s post-mortem organ donation programme, the Kerala Network for Organ Sharing (KNOS/K-SOTTO), calling it a “complete failure.” 

In a social media post mourning the death of former nephrology head Dr Venugopal, the present HoD Dr Mohan Das said that the project had lost its success after the passing of Dr Ramdas, who played a key role in building the Mrithasanjeevani (K-SOTTO) initiative. 

“It was Dr Venugopal and Dr Ramdas who made the Mrithasanjeevani project in Kerala a success. With the death of Dr Ramdas, Mrithasanjeevani has become a total failure,” he said in the post. 

Also read- 3rd year female MD Medicine medico attacked by patient kin at Thiruvananthapuram Medical College

He also pointed out that not even a single cadaver transplant had taken place at Alappuzha Medical College, despite it being the base of the K-SOTTO executive director. However, Das later deleted the post. 

Responding to the criticism, the Principal of Thiruvananthapuram Medical College, Dr PK Jabbar, issued a strict directive to doctors, barring them from making public statements. He warned of strict disciplinary action against violations of service rules, reports Onmanorama.

The criticism came almost two months after Dr Haris Chirakal publicly disclosed the shortage of surgical equipment and delays in surgeries at the state-run Thiruvananthapuram Medical College Hospital.

Medical Dialogues had previously reported that a social media post by a leading senior urologist disclosing a shortage of surgical equipment and delays in surgeries for months at the state-run Thiruvananthapuram Medical College Hospital has gained widespread attention and landed him in an open fight against the health department, all for the sake of his patients.

Dr Haris Chirakkal, Head of the Urology Department at Thiruvananthapuram Medical College Hospital, shared a detailed Facebook post, which is now deleted, where he highlighted the grim situation at the hospital as he could no longer stay silent as a doctor. Although Dr Chirakkal agreed to delete his Facebook post at the DME’s request, he later told reporters that the issues he raised persist.

In his post, he expressed his frustration after repeated delays in surgeries due to a lack of basic medical equipment. He pointed out that doctors are left helpless as patients wait for critical surgeries for months, only to have them cancelled due to the unavailability of essential medical equipment. As a result, poor patients and their families are left confused and hopeless, not knowing what to do next, he added.

Also read- Thiruvananthapuram Medical College courts Equipment Controversy after leading Urologist take to social media to point deficiencies

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Finerenone Benefits Consistent Across Diuretic Subgroups in HFmrEF/HFpEF: JAMA

A new study published in the Journal of American Medical Association showed that although it did not decrease the incidence of new loop diuretic introduction in patients who were not on them at baseline, finerenone’s safety and effectiveness were constant across all diuretic subgroups, lowering total diuretic usage in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF).

The effectiveness and safety of mineralocorticoid receptor antagonists in combination with other diuretics, as well as whether they have a so-called diuretic-sparing effect in patients with heart failure (HF), should be assessed due to their renal effects.

Thereby, to investigate the effectiveness and tolerance of finerenone in conjunction with background diuretic medication in patients with HFmrEF/HFpEF, this research was carried out.

This study is a predetermined secondary analysis of the FINEARTS-HF randomly assigned clinical trial, which was carried out among adults 40 years of age and older with HFmrEF/HFpEF across 653 sites in 37 countries. The trial was randomized between September 2020 and January 2023. Analysis of the data took place between December 1, 2024, and January 30, 2025.

The composite of all heart attacks and cardiovascular deaths was the main result. Results were compared between finerenone and placebo based on the following baseline diuretic categories: loop diuretic (≤40 mg vs. >40 mg dosage of furosemide equivalent); solely nonloop diuretic (thiazide or thiazide-like); and combination non-loop and loop diuretic treatment.

Of the 5,438 patients, the mean (SD) age was 72.1 (9.6) years, and 2496 (45.9%) were female. In all, 684 patients (12.6%) were using a nonloop diuretic, 3040 patients (55.7%) were taking less than or equal to 40 mg of furosemide equivalent, 1145 patients (21.1%) were taking 40 mg or more, and 569 patients (10.5%) were taking both nonloop and loop diuretics. 

In all diuretic subgroups, finerenone decreased the risk of the primary end point when compared to placebo: rate ratios for patients in the nonloop, 40 mg or less loop, more than 40 mg loop, and combined nonloop and loop categories were 0.84 (95% CI, 0.47-1.51), 0.86 (95% CI, 0.72-1.02), 0.98 (95% CI, 0.78-1.24), and 0.54 (95% CI, 0.35-0.83), respectively.

Finerenone decreased loop diuretic dosage and dose intensification but not loop diuretic beginning when compared to a placebo. The safety of each diuretic category was the same.

Overall, all diuretic subgroups benefited equally on finerenone. Finerenone decreased the requirement for loop diuretic dosage intensification and decreased the mean loop diuretic dose, but it did not substantially lower the introduction of a loop diuretic in patients who were not receiving loop diuretics at baseline when compared to placebo.

Source:

Chimura, M., Jhund, P. S., Henderson, A. D., Yang, M., Claggett, B. L., Desai, A. S., Rohwedder, K., Lage, A., Scalise, A., Mueller, K., Schou, M., Lam, C. S. P., Senni, M., Voors, A. A., Zannad, F., Pitt, B., Vaduganathan, M., Solomon, S. D., & McMurray, J. J. V. (2025). Efficacy and tolerability of finerenone according to the use and dosage of diuretics: A prespecified analysis of the FINEARTS-HF randomized clinical trial. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2025.2551

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Couples Share High Cardiometabolic Risk After Gestational Diabetes, Study Reveals

Denmark: Women diagnosed with gestational diabetes mellitus (GDM) often share significant cardiometabolic health risks with their partners, highlighting an opportunity for couple-based preventive strategies, according to a recent study published in Diabetes, Obesity and Metabolism.

The research led by Majken Lillholm Pico, MSc, from the Department of Prevention, Health Promotion and Community Care at Copenhagen University Hospital – Steno Diabetes Center Copenhagen, assessed 196 couples 12 weeks after a GDM-affected pregnancy. Health examinations and questionnaires evaluated overweight or obesity, waist circumference, metabolic syndrome, impaired fasting glucose, stage 1 or higher hypertension, as well as dietary quality and physical activity.

The study led to the following findings:

  • Overweight or obesity was observed in 63.3% of women and 71.9% of partners, with 50.5% of couples sharing this condition.
  • High waist circumference was recorded in 78.6% of women and 55.1% of partners, with concordance in 48.5% of couples.
  • Metabolic syndrome was found in 9.2% of women and 24.0% of partners, with 5.1% of couples affected together.
  • Impaired fasting glucose affected 7.7% of women and 9.2% of partners, with both partners affected in 1.5% of couples.
  • Stage 1 or higher hypertension occurred in 31.1% of women and 55.6% of partners, with 8.2% of couples having concordant cases.
  • Having a cardiometabolic condition in one partner was linked to a higher likelihood of the same condition in the other, independent of demographic, socioeconomic, and lifestyle factors, except for male partners with stage 1 hypertension, where adjustments explained the association.

The authors noted that detecting GDM could serve as an early warning sign for identifying partners at risk, paving the way for family-focused interventions targeting diet, exercise, and weight control.

However, several limitations were acknowledged. The cross-sectional design restricts conclusions about causality, and the timing—just 12 weeks postpartum—may overestimate overweight prevalence in women. Lifestyle behaviours at this stage may also not reflect long-term patterns. Furthermore, the cut-offs used for overweight, obesity, and waist circumference were based on European standards, potentially misclassifying participants of non-European origin (around 10% of the sample).

The researchers also pointed out that physical activity measures might have been overestimated due to the questionnaire method, and the absence of a comparison group without GDM made it difficult to determine whether these risks are unique to such couples. Additionally, couples participating in the study tended to have more favourable socioeconomic profiles, which may limit generalizability.

Despite these constraints, the findings highlight the need for couple-oriented prevention strategies in the aftermath of GDM. “The high prevalence and concordance of cardiometabolic markers suggest that interventions involving both partners could amplify health benefits,” the authors noted. Such approaches, integrated into broader diabetes prevention programs, could support early risk detection and sustained lifestyle improvements.

“Further research is warranted to determine how effectively couple-based programs can reduce cardiometabolic risks in families affected by GDM and improve long-term health outcomes for both partners,” they concluded.

Reference:

Pico ML, Maindal HT, Grunnet LG, Damm P, Jensen DM, Ovesen P, Dahl-Petersen IK, Vinter CA, Kampmann U, Mathiesen ER, Nielsen KK; Face‐it Study Group. Prevalence and concordance of cardiometabolic risk markers and health behaviour among couples after a gestational diabetes mellitus-affected pregnancy. Diabetes Obes Metab. 2025 Aug 8. doi: 10.1111/dom.70017. Epub ahead of print. PMID: 40776803.

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‘Weekend warriors’ with diabetes have a 33% lower risk of cardiovascular mortality: Study

A prospective cohort study examined the associations of different physical activity patterns with all-cause, cardiovascular (CV) and cancer mortality among adults with diabetes. The study found that weekend warrior and regular activity patterns meeting current physical activity recommendations were associated with similarly reduced risks for all-cause and cardiovascular mortality compared to physical inactivity, demonstrating the importance of any physical activity for people with diabetes. The results are published in Annals of Internal Medicine.

Researchers from Harvard T.H. Chan School of Public Health, Boston University School of Public Health, Vanderbilt University Medical Center, Capital Medical University, and colleagues studied data from 51,650 adults with self-reported diabetes who participated in the National Health Interview Survey (NHIS) between 1997 and 2018. Current guidelines recommend at least 150 minutes per week of moderate-to-vigorous physical activity (MVPA) distributed across a minimum of three days.

Participants were categorized into four activity patterns: inactive (no reported MVPA); insufficiently active (MVPA less than 150 minutes per week); weekend warrior (MVPA 150 or more minutes per week across one to two sessions); and regularly active (MVPA 150 or more minutes per week across at least three sessions).

The researchers found that insufficiently active, weekend warrior, and regularly active participants had lower risks for all-cause and cardiovascular mortality compared to inactive participants. Weekend warriors and regularly active participants had a 21% and 17% lower all-cause mortality risk and 33% and 19% lower risks of cardiovascular mortality, respectively, compared with inactive participants. There were fewer differences by cancer mortality compared with physical inactivity.

Reference:

Zhiyuan Wu, Association of Weekend Warrior and Other Physical Activity Patterns With Mortality Among Adults With Diabetes: A Cohort Study, Annals of Internal Medicine, https://doi.org/10.7326/ANNALS-25-00640 

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AI risk assessment for CVD effective non-invasive alternative: Study

A new study published in the Npj Digital Medicine journal revealed how the risk assessment system cardiovascular disease (rpCVD) technique may be used to assess CVD risk in primary care settings more quickly, easily, and non-invasively without requiring more involved clinical tests.

The real-world adoption of CVD risk assessment remains below ideal, even though there are well-validated instruments for assessing this risk, such as the pooled cohort equations (PCE) for American populations and the QRISK3 and SCORE2 for European populations. This project evaluated an automated retinal photography and artificial intelligence (AI)-based rpCVD in primary care settings in Australia for real-world accuracy (primary result), practicality, and acceptance (secondary objectives).

For this study participants were selected from 2 general practice clinics in Victoria, Australia, who were between the ages of 45 and 70 and had recently completed all or part of a CVD risk assessment. The participants gave their assent, underwent retinal imaging with an automated fundus camera, and a deep learning system produced a rpCVD risk score. The World Health Organization’s (WHO) CVD risk score, which takes into account clinical risk variables including age and sex, was compared to this score.

Using data from the UK Biobank, the prediction accuracy of the WHO CVD risk scores and rpCVD risk scores for 10-year incident CVD occurrences was examined. The accuracy of each system was measured using the area under the receiver operating characteristic curve (AUC). A survey was used to gauge participant satisfaction, and the proportion of people having pictures good enough to generate a rpCVD risk score was used to calculate the imaging success rate.

A 93.9% imaging success rate was achieved by assigning a rpCVD risk score to 339 out of the 361 individuals. There was a moderate association between the WHO CVD risk scores and the rpCVD risk scores.

In spite of this, the WHO CVD risk score (AUC = 0.693, 95% CI: 0.680-0.707) and the rpCVD system, which only uses retinal pictures, showed comparable accuracy in predicting 10-year incident CVD (AUC = 0.672, 95% CI: 0.658-0.686). Nearly, 87.5% of general practitioners (GPs) and 92.5% of participants expressed satisfaction with the system, indicating high levels of satisfaction.

Using just retinal photos, the automated rpCVD system showed predicted accuracy on par with the WHO CVD risk score, which takes into account a number of clinical parameters, including age, which is the most heavily weighted factor for predicting CVD. Overall, the automated rpCVD screening method is viable and well accepted in Australian primary care, as this study shows. 

Source:

Hu, W., Lin, Z., Clark, M., Henwood, J., Shang, X., Chen, R., Kiburg, K., Zhang, L., Ge, Z., van Wijngaarden, P., Zhu, Z., & He, M. (2025). Real-world feasibility, accuracy and acceptability of automated retinal photography and AI-based cardiovascular disease risk assessment in Australian primary care settings: a pragmatic trial. Npj Digital Medicine, 8(1), 122. https://doi.org/10.1038/s41746-025-01436-1

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Diet rich in omega-3 fatty acids may help ward off short sightedness in children: Research

A diet rich in omega-3 fatty acids, found predominantly in fish oils, may help ward off the development of short sightedness (myopia) in children, while a high intake of saturated fats, found in foods such as butter, palm oil, and red meat, may boost the risk of the condition, finds research published online in the British Journal of Ophthalmology.

The global prevalence of myopia is rising, especially in East Asia, and it’s predicted that around half of the world’s population will be affected by 2050, note the researchers.

Risk factors are thought to include excessive screen time and too little time spent outdoors, as well as inherited susceptibility, they explain.

Omega-3 polyunsaturated fatty acids (ω-3 PUFAs), which can only be obtained from the diet, are thought to improve/prevent several chronic eye conditions, including dry eye disease and age-related macular degeneration. But whether they can help ward off myopia isn’t clear as studies to date have been experimental and haven’t included people.

To explore this further, the researchers drew on 1005 Chinese 6-8 year olds, randomly recruited from the population based Hong Kong Children Eye Study, which is tracking the development of eye conditions and potential risk factors.

The children’s eyesight was assessed and their regular diet measured by a food frequency questionnaire, completed with the help of their parents. This included 280 food items categorised into 10 groups: bread/cereals/pasta/rice/noodles; vegetables and legumes; fruit; meat; fish; eggs; milk and dairy products; drinks; dim sum/snacks/fats/oils; and soups.

Intakes of energy, carbohydrate, proteins, total fat, saturated fats, monounsaturated fats, PUFAs, cholesterol, iron, calcium, vitamins A and C, fibre, starch, sugar and nutrients were then calculated, based on the questionnaire responses.

The amount of time the children spent outdoors in leisure and during sports activities, reading and writing, and on screens during weekdays and at the weekend was calculated from validated questionnaire responses.

In all, around a quarter of the children (276; 27.5%) had myopia. Higher dietary intake of omega-3 fatty acids was associated with a lower risk of the condition.

Axial length-measurement of the eye from the cornea at the front to the retina at the back, and an indicator of myopia progression—was longest in the 25% of children with the lowest dietary intake of omega-3 fatty acids, after accounting for influential factors, including age, sex, weight (BMI), the amount of time spent in close work and outdoors, and parental myopia.

It was shortest in the 25% of children with the highest dietary intake of omega-3 fatty acids.

Similarly, cycloplegic spherical equivalent (SE), which measures refractive error, such as the degree of shortsightedness, was highest in those with the lowest omega-3 fatty acid intake and lowest in those with the highest intake.

But these findings were reversed for the 25% of children with the highest saturated fat intake, compared with the 25% of those with the lowest. None of the other nutrients was associated with either measure or myopia.

This is an observational study, and as such, can’t establish causal and temporal factors. And the researchers acknowledge that food frequency questionnaires rely on recall and only provide a snapshot in time of diet. Nor was there objective evidence of nutritional intake from blood samples.

The prevalence of myopia in Hong Kong is also among the highest in the world. And whether the findings might apply to other ethnic groups with different lifestyles and less myopia remains to be verified, they add.

But omega-3 fatty acids may suppress myopia by increasing blood flow through the choroid, a vascular layer in the eye, responsible for delivering nutrients and oxygen, and so staving off scleral hypoxia-oxygen deficiency in the white of the eye and a key factor in the development of shortsightedness, they suggest.

And they conclude: “This study provides the human evidence that higher dietary ω-3 PUFA intake is associated with shorter axial length and less myopic refraction, highlighting ω-3 PUFAs as a potential protective dietary factor against myopia development.”

Reference:

Dietary omega-3 polyunsaturated fatty acids as a protective factor of myopia: the Hong Kong Children Eye Study Doi: 10.1136/bjo-2024-326872

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Er:YAG Laser Plus 60s Acid Etch Restores Bonding in Fluorotic Enamel: Study

According to a new study use of an Er:YAG laser at 100 mJ/30 Hz combined with 60 seconds of acid etching produces excellent adhesion for attachments on fluorotic enamel — restoring bond strength to levels comparable with healthy enamel while avoiding over-etching damage. The researchers found that this approach avoids the risk of over-etching, which can damage enamel structure, while still achieving strong adhesion for orthodontic attachments. Dental fluorosis can alter the mineralization of enamel, making it more resistant to acid etching and reducing bond strength for orthodontic brackets or attachments. Standard etching protocols often fail to achieve optimal adhesion, and aggressive etching may compromise the enamel surface. In this study, the laser-plus-acid combination created an ideal surface texture for micromechanical interlocking without excessive enamel loss. The findings suggest that this protocol could offer clinicians a predictable and safe way to manage bonding challenges in patients with dental fluorosis. By fine-tuning the laser energy and etching duration, the researchers were able to overcome the adhesion limitations of fluorotic enamel while preserving tooth integrity. The authors note that further clinical trials are needed to confirm these in vitro results and evaluate long-term bond durability under oral conditions. If validated, this method could improve treatment outcomes in orthodontics, particularly in regions where fluorosis prevalence is high.

Reference:
Xia R, Lei J, Luo M, Xiao Y (2025) Effects of Er: YAG laser and acid etching on bond strength of clear aligner attachments to fluorotic enamel. PLoS One 20(8): e0328937. https://doi.org/10.1371/journal.pone.0328937

Keywords:

Er:YAG laser, dental fluorosis, acid etching, enamel bonding, orthodontics, attachment adhesion, surface preparation

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Iontophoresis and low-dye taping are effective conservative interventions for plantar fasciitis: study

Plantar fasciitis (PF) is a frequent cause of heel pain, affecting approximately 10% of the population. Conservative treatments such as iontophoresis and low-dye taping (LDT) are widely used to alleviate symptoms, often providing short-term pain relief.

Aurora Castro‑Mendez et al conducted a systematic review to compare the efficacy of iontophoresis (with 5% acetic acid, 0.4% dexamethasone, dexamethasone and lidocaine, or placebo) versus low-dye taping (LDT) in treating plantar fasciitis. Additionally, it evaluated the combined effect of iontophoresis and LDT application.

A systematic search was conducted in Scopus, PubMed, Web of Science, CINAHL, and the Cochrane Library databases, following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Inclusion and exclusion criteria were predefined. Two independent reviewers screened and extracted data from eligible studies, assessing their quality. Included studies comprised randomized controlled trials, non-randomized clinical trials, case–control studies, systematic reviews, and meta-analyses. The review protocol was registered with PROSPERO.

Key findings of the study were:

• Eight studies published between 1997 and 2018 were included, providing a moderate level of evidence.

• Both iontophoresis (with the specified agents) and low-dye taping, alone or combined, were associated with statistically significant reductions in pain scores compared to baseline.

The authors concluded – “Iontophoresis and low-dye taping are effective conservative treatments for reducing foot pain in adults with plantar fasciitis. However, evidence from this review suggests that the combined use of iontophoresis and LDT provides superior pain relief compared to either treatment alone. Among the substances used, 5% acetic acid appears to be the most effective when applied via iontophoresis.

Nevertheless, the current body of research is limited by heterogeneity in methodologies, small sample sizes, and short-term follow-up. Future studies should aim to standardize treatment protocols, use consistent outcome measures, and include larger populations with long-term follow-up to better assess the durability of therapeutic effects.”

Further reading:

Comparative Effectiveness of Iontophoresis vs. Low Dye Taping in Plantar Fasciitis: A Systematic Review

Aurora Castro‑Mendez et al

Indian Journal of Orthopaedics

https://doi.org/10.1007/s43465-025-01477-4

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Fertility-Related Factors May Predict Osteoporosis Risk in Postmenopausal Women, claims research

Researchers have discovered in a new study that infertility, miscarriage, stillbirth, and having fewer children might raise the risk of osteoporosis among women undergoing natural menopause. The large international study concluded that these reproductive factors for health are independently linked to bone loss in older age, and that age at natural menopause doesn’t entirely account for these associations. These results indicate that reproductive history may be an important factor in the early recognition of women who are at high risk for osteoporosis, and in steering preventive measures to minimize long-term morbidity. The study was conducted by LIANG Chen and fellow researchers published in the journal of Fertility and Sterility.

This research, undertaken under the auspices of the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE), combined data from 141,222 naturally postmenopausal women from five cohorts. It was designed to test two overarching hypotheses: whether reproductive difficulties like infertility, miscarriage, stillbirth, and low parity are related to elevated risk of osteoporosis, and whether menopausal age might explain these relationships.

This pooled analysis employed retrospective and prospective data from five cohorts from around the world who belonged to the InterLACE consortium. Excluding women who had undergone unnatural menopause and those for whom reproductive history, osteoporosis status, and covariates were incomplete, the researchers included only those women who met these criteria. Major exposures to infertility, miscarriage, stillbirth, and parity were reported by participants themselves.

Diagnoses of osteoporosis were derived from various sources of data, such as surveys, hospital discharge records, death registers, primary care data, and records of drug use. Cox regression models were used by researchers to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between factors related to fertility and osteoporosis risk. Models were also adjusted for key covariates including race, age, education, smoking, alcohol consumption, BMI, physical activity, and age at menarche, with a further step adjusting for age at natural menopause as a time-varying covariate.

Key Findings

Modest but persistent elevated risks of osteoporosis in women with unfavorable reproductive histories were found by the study:

  • Infertility history was linked with a 16% increased risk of osteoporosis (HR=1.16, 95% CI: 1.13–1.19).

  • Women with three or more miscarriages had 17% increased risk (HR=1.17, 95% CI: 1.05–1.30).

  • Those who had stillbirth had 14% increased risk (HR=1.14, 95% CI: 1.10–1.17).

  • No live births: HR=1.20 (95% CI: 1.15–1.25)

  • One live birth: HR=1.15 (95% CI: 1.14–1.16)

This big international study verifies that infertility, habitual miscarriage, stillbirth, and low parity are associated with higher risk of osteoporosis in naturally postmenopausal women. These relationships remained significant even after controlling for age at menopause, indicating an independent contribution of reproductive factors in bone health. Physicians can think of these reproductive markers as preliminary indicators for osteoporosis risk assessment and individualized prevention measures.

Reference:

Chen, L. I. A. N. G., Chung, H.-F., Anderson, D. J., VAN DER Schouw, Y. T., Avis, N. E., Karvonen-Gutierrez, C. A., Dobson, A. J., & Mishra, G. D. (2025). The association of infertility, miscarriage, stillbirth, and parity with osteoporosis: a pooled analysis of five cohort studies. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2025.07.382

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Ureteroscopy and Shockwave Lithotripsy exhibit Similar kidney stone Clearance: JAMA

A new study published in the Journal of American Medical Association found that despite shockwave lithotripsy and ureteroscopy having comparable kidney stone clearance rates, patients felt that shockwave lithotripsy was a superior overall experience.

Despite the ambiguity and equal weight of guidelines for shockwave lithotripsy and ureteroscopy, ureteroscopy is the most common treatment for kidney and ureteral stones in children and adolescents. Thus, to assess stone clearance and patient-reported outcomes following ureteroscopy or shockwave lithotripsy, this study was carried out in children and adolescents.

The patients were recruited for this nonrandomized clinical research at 31 US and Canadian medical facilities between March 16, 2020, and July 31, 2023. The patients with ureteral stones, kidney stones, or both who were between the ages of 8 and 21 were included. The last day of follow-up was October 15, 2023.

6 (±2) weeks following surgery, the main result was the stone removal measured by standardized ultrasonography. Stone clearance was assessed per kidney or ureter using logistic regression, and estimated stone clearance rates were produced for each operation using inverse probability weighting and random intercepts each location.

A total of 1,142 patients (690 females [60.4%]) with a median age of 15.6 years (IQR, 12.6-17.3 years) were included in this research. Regarding race and ethnicity, 884 patients (77.4%) were White, 130 patients (11.4%) were Hispanic, and 41 patients (3.6%) were Black.

A median stone size of 6.0 mm (IQR, 4.0-9.0 mm) was found in 1069 kidneys or ureters treated by 124 urologists using ureteroscopy and shockwave lithotripsy (n = 953 and 189 patients), respectively.

Almost, 841 operations for 767 patients (80.4%) undergoing ureteroscopy and 6 procedures for 5 patients (2.6%) undergoing shockwave lithotripsy involved the placement of ureteral stents at the time of index surgery.

In 105 patients who had shockwave lithotripsy (67.5% [95% CI, 61.0%-74.1%]) and 474 patients who had ureteroscopy (71.2% [95% CI, 63.8%-78.5%]), stone removal was achieved; however, this difference was not statistically significant (risk difference, 3.6% [95% CI, −6.2% to 13.5%]).

One week following surgery, ureteroscopy caused more urinary symptoms (symptom score difference, 3.9 [95% CI, 1.2-6.7]) and discomfort interference (T-score difference, 5.0 [95% CI, 2.3-7.8]) than shockwave lithotripsy.

In the week after surgery, ureteroscopy patients missed more coursework (risk difference: 21.3% [95% CI: 9.7%-32.8%]) and caregivers missed more work (risk difference: 23.0% [95% CI: 11.0%-35.0%]). Overall, improved patient-reported outcomes were linked to shockwave lithotripsy. 

Reference:

Tasian, G. E., Chu, D. I., Nelson, C. P., DeFoor, W. R., Ziemba, J. B., Huang, J., Luan, X., Kurtz, M., Ching, C. B., Dangle, P., Schaeffer, A. J., Sturm, R., Wu, W., Bayne, C., Fernandez, N., Chua, M. E., DeMarco, R., Ellsworth, P., Augelli, B., … Meenakshi-Sundaram, B. (2025). Ureteroscopy vs shockwave lithotripsy to remove kidney stones in children and adolescents: A nonrandomized clinical trial: A nonrandomized clinical trial. JAMA Network Open, 8(8). https://doi.org/10.1001/jamanetworkopen.2025.25789

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