Parenchymal damage and renal function impairment following percutaneous nephrolithotomy (PCNL) are of great concern. This study aims to evaluate post-operative changes in renal volume after PCNL. We retrospectively analyzed baseline and post-PCNL CT images from 25 eligible patients from a single tertiary care center. All CT imaging was reviewed using 3D planimetry software (3D Splicer®, Version 4.0). Segmentation was utilized to obtain total kidney volume (TKV), total kidney surface area, total stone surface area, and total stone volume. Wilcoxon signed-rank test was used for pair analysis, and univariate and multivariable analyses were performed to examine the relationships between clinical and planimetry data and renal volume loss. The median age of the cohort was 62 years, with the majority of the patients having undergone a previous PCNL (52.0%). The median TKV (cm3) pre- and post-PCNL were 225.25 and 178.09, respectively (p = 0.001), with average volume decline of 21%. While there was a statistically significant kidney volume loss in our cohort, there was no difference between pre- and post-operative serum creatinine (mg/dL): 0.93 and 0.94 (p = 0.696), respectively. Multivariable analysis showed a higher TKV loss with a larger kidney stone surface area (OR 1.002, CI 1–1.003, p = 0.035), while younger age was found to be protective (OR 0.791, CI 0.587–0.925 p = 0.028). Patients with previous history of PCNL experiences a more pronounced TKV loss (53.77 cm3, p = 0.031), as compared to PCNL naïve patients (13.05 cm3, p = 0.224). Our study consistently revealed a decrease in TKV following PCNL. Furthermore, among patients with larger stone surface areas, and history of previous PCNL there was an increase in the loss of TKV after the procedure.

ObjectivesTo compare the enucleation efficiency of Moses 2.0 with non‐Moses technology in patients undergoing holmium laser enucleation of the prostate (HoLEP).Patients and MethodsA double‐blinded, randomised study of patients undergoing HoLEP at the Mayo Clinic in Arizona, using the Lumenis Pulse™ 120H laser system. Patients were randomised to either right lobe enucleation using Moses 2.0 and left lobe enucleation using non‐Moses, or the opposite. The primary outcome was individual lobe enucleation efficiency. Secondary outcomes included individual lobe laser time, laser energy, individual enucleation and haemostasis laser energies, and fibre burn back. Two independent reviewers watched videos of the procedures and provided a subjective evaluation of the technologies.ResultsA total of 27 patients were included in the study. For the entire cohort, Moses 2.0 had less fibre degradation (3.5 vs 16.8 mm, P < 0.01) compared to non‐Moses. When HoLEP procedures were performed by an expert, Moses 2.0 resulted in shorter enucleation time (21 vs 36.7 min, P = 0.016) and higher enucleation efficiency (1.75 vs 1.05 g/min, P = 0.05) compared to non‐Moses. When HoLEP was performed by trainees, the Moses 2.0 cohort had a shorter haemostasis laser time (4.1 vs 9 min, P = 0.035) compared to the non‐Moses. Fibre degradation was lower with Moses 2.0 compared to non‐Moses for both experts and trainees. Moses 2.0 received a higher score than the standard technology for the incision sharpness, fibre control, tissue separation, tissue damage, haemostasis, visibility, and charring. The overall inter‐observer correlation coefficient was 0.63.ConclusionMoses 2.0 has higher enucleation efficiency compared to non‐Moses when used by experts. The subjective evaluation favoured Moses 2.0.

Purpose: The etiology of calcium-oxalate kidney stone formation remains elusive. Biallelic mutations in HOGA1 are responsible for primary hyperoxaluria type 3 and result in oxalate overproduction and kidney stone disease. Our previous study showed that carriers of HOGA1 mutations have elevated urinary levels of oxalate precursors. In this study we explored the possibility that mutations in HOGA1 confer a dominant phenotype in the form of kidney stone disease or hyperoxaluria. Materials and Methods: An observational analytic case control study was designed to determine the prevalence of pathogenic HOGA1 mutations among adults with calcium-oxalate kidney stone disease. Given the high prevalence of HOGA1 mutations among Ashkenazi Jews, this group was evaluated separately. Carrier frequency of any of the 52 reported pathogenic mutations was compared to data derived from gnomAD for the corresponding ethnic group. Sanger sequencing of HOGA1 gene was performed on DNA samples from the following groups: 60 Ashkenazi Jews and 86 nonAshkenazi calcium-oxalate stone formers, 150 subjects with low and 150 with high urinary oxalate levels. Results: The carrier prevalence of pathogenic mutations among the Ashkenazi Jews was 1.7% compared to 2.8% in the corresponding control group (p=0.9 OR=0.6 95% CI 0.01-3.51). We did not detect any mutation among the nonAshkenazi study group. No correlation was detected between hyperoxaluria and HOGA1 variants. Conclusions: This study shows that mutations in HOGA1 do not confer a dominant phenotype in the form of calcium-oxalate kidney stone disease or hyperoxaluria.

Objective: To evaluate the accuracy of transrectal ultrasound (TRUS), computed tomography (CT), and magnetic resonance imaging (MRI) compared to the reference standard of the post-surgical anatomic prostatic weight (APW). Material and methods: A total of 349 patients from two institutions were included. The CT and MRI dimensions, and TRUS-reported prostate volumes (PV) were obtained. The prolate ellipsoid formula was used to calculate PV. Cross-sectional measurements were evaluated and compared to the reported post-surgical pathology measurements and calculated pathology volume (path PV). A basic statistical analysis was performed using the Pearson correlation, Bland-Altman analysis, and Passing-Bablok regression. Results: A total of 198 patients were included in the MRI group, 118 in the CT group, 295 in the TRUS group, and 51 in the all-inclusive common cohort. The MRI PV demonstrated a good to excellent correlation with the APW (r=0.79). The CT PV demonstrated a good correlation with APW (r=0.78). The TRUS PV showed a correlation with APW (r=0.67). The correlations identified in each individual group held true in the common cohort as well. The path PV showed an excellent correlation with APW (r=0.87), followed by MRI PV (r=0.81), then CT PV (r=0.73), and lastly TRUS PV (r=0.71). Conclusion: MRI and CT are equally effective in assessing the PV, and they can be readily utilized to guide the benign prostatic hyperplasia (BPH) management without repeating in-office TRUS. This is not only cost-effective, but also eliminates patient anxiety and discomfort.

Abstract Stone formation is a complex process, mainly because stone disease is a polygenic, multifactorial disorder that involves an interrelationship between the kidney, bone, and intestine. Although great progress has been made in recent years to delineate the exact processes that lead to the formation of renal calculi, there are many incompletely answered questions regarding pathogenesis of stone formation. There are distinct stone phenotypes and the cascade of events leading to kidney stone formation varies depending on this phenotype. Different mechanisms of stone formation have been described for numerous stone types and clinical situations. Herein, we reviewed the current knowledge about the basic pathophysiologic theories involved in the formation of different renal calculi.

We herein report an unusual case of testicular torsion a decade after orchiopexy. An occurrence of postorchiopexy testicular torsion is an exceedingly rare event, infrequently reported in literature. Previously placed anchoring sutures in the inferior pole resulted in a "hammock" testicular torsion, resulting in twisting of cord with involvement of the sutures themselves.

Background: Variability in prices of medications is a well-known phenomenon; however, this variability has not been quantified in the realm of erectile dysfunction (ED) medications. ED medications are ideal for this quantification, because they are often not covered by insurances; therefore, the cost is the most direct reflection of price variability among pharmacies as they affect the patients. Aim: To evaluate the variability in cash prices for phosphodiesterase type 5 inhibitors (PDEIs) for ED. We also evaluated whether certain types of pharmacies consistently offer better pricing than others, and whether there was any correlation with demographic factors. Methods: 331 pharmacies were contacted within a 25-mile radius of our institution to obtain the cash price for 4 commonly used ED medications with prespecified doses. After exclusion, 323 pharmacies were categorized as chain, independent, wholesale, or hospital-associated. Cash prices for the specified medications were evaluated. In addition, we identified demographic and socioeconomic factors to determine if these had an impact on median drug pricing within each zip code. Main Outcome Measure: The main outcome was the cost for patients to fill each prescription. Results: Independent pharmacies provided the lowest cost for 3 of 4 of the PDEIs. The largest price difference for 10 tablets of 100 mg sildenafil between all pharmacies was 38,000%. The median cost difference between independent pharmacies and chain pharmacies for sildenafil was >900%, and >1,100% for independent pharmacies vs hospital-associated pharmacies. Demographic and socioeconomic factors had no impact on the cost. Clinical Implications: Our goal is to promote patient counseling among practitioners and to empower patients to shop for the best prices for their medications. Strength and Limitations: A strength of the study is the large cohort that was surveyed; however, a weakness is that the large majority of the cohort was comprised of chain pharmacies. Mail pharmacies could not be evaluated as they required a valid prescription before offering prices. Conclusion: The drastic differences in cash prices for the PDEIs give us an insight into the variability and cost-inflation of medications in the United States. These patterns hold true for other essential medications as well, and improved transparency will allow patients to make informed decisions when choosing where to purchase their medications. It may also encourage certain pharmacies to provide medications at more affordable prices. Copyright (C) 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Purpose: We examine the relationship between urine and stone cultures in a large cohort of patients undergoing percutaneous stone removal and compare the findings in infectious vs metabolic calculi.Materials and Methods: A total of 776 patients treated with percutaneous nephrolithotomy who had preoperative urine cultures and intraoperative stone cultures were included in the study. Statistical analysis used chi-square or logistic fit analysis as appropriate.Results: Preoperative urine culture was positive in 352 patients (45.4%) and stone cultures were positive in 300 patients (38.7%). There were 75 patients (9.7%) with negative preoperative cultures who had positive stone cultures, and in patients with both cultures positive the organisms differed in 103 (13.3%). Gram-positive organisms predominated in preoperative urine and stone cultures.Conclusions: Preoperative urine cultures in patients undergoing percutaneous nephrolithotomy are unreliable as there is a discordance with intraoperative stone cultures in almost a quarter of cases. There has been a notable shift toward gram-positive organisms in this cohort of patients.

You have accessJournal of UrologyStone Disease: Basic Research II1 Apr 2015MP34-19 SURGICAL FACTORS CONTRIBUTING TO THE ACUTE REDUCTION IN RENAL FUNCTION AFTER PERCUTANEOUS NEPHROLITHOTOMY. Rajash Handa, Cynthia Johnson, Bret Connors, Jessica Mandeville, Ehud Gnessin, Amy Krambeck, Naeem Bhojani, Marawan El Tayeb, Andrew Evan, and James Lingeman Rajash HandaRajash Handa More articles by this author , Cynthia JohnsonCynthia Johnson More articles by this author , Bret ConnorsBret Connors More articles by this author , Jessica MandevilleJessica Mandeville More articles by this author , Ehud GnessinEhud Gnessin More articles by this author , Amy KrambeckAmy Krambeck More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Marawan El TayebMarawan El Tayeb More articles by this author , Andrew EvanAndrew Evan More articles by this author , and James LingemanJames Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1315AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical option for removing stones from the renal collecting system and involves gaining access to the collecting system by advancing an 18-gauge needle through the skin and kidney until the needle tip enters the urinary collecting system. The needle access tract is subsequently expanded and stabilized so that a sufficiently large channel (nephrostomy tract) is created for the introduction of endoscopic instrumentation to remove stone(s). Studies in patients and experimental animals have shown that PCNL can acutely impair glomerular filtration and renal perfusion, but the factors contributing to this decline in renal function are unknown. The focus of the present study was to identify the procedural steps in PCNL surgery that contribute to the acute decline in renal hemodynamic function. METHODS Acute experiments were performed in 3 groups of anesthetized adult farm pigs: no surgical procedure (n=7); a single-needle stick to access the renal urinary collecting system (n=8); expansion of the single-needle access tract with a 30f NephroMax balloon dilator and insertion of a nephrostomy sheath (n=9). Renal plasma flow was assessed by the renal clearance of para-aminohippuric acid before and 1 h after sham-PCNL or the PCNL surgical procedures. RESULTS Control pigs that did not undergo surgery showed no significant change in renal plasma flow over the experimental observation period. In contrast, a single-needle stick to access the urinary collecting system resulted in renal vasoconstriction (25% reduction in renal plasma flow, P<0.05). Single-needle access plus creation of the nephrostomy tract did not lead to a further decline in renal plasma flow. CONCLUSIONS The renal vasoconstriction observed after PCNL surgery is largely due to the act of inserting a needle into the kidney for percutaneous access to the urinary collecting system. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e417-e418 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajash Handa More articles by this author Cynthia Johnson More articles by this author Bret Connors More articles by this author Jessica Mandeville More articles by this author Ehud Gnessin More articles by this author Amy Krambeck More articles by this author Naeem Bhojani More articles by this author Marawan El Tayeb More articles by this author Andrew Evan More articles by this author James Lingeman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Purpose: We determined whether shock wave lithotripsy of the kidney of pigs with metabolic syndrome would worsen glucose tolerance or increase the risk of diabetes mellitus.Materials and Methods: Nine-month-old female Ossabaw miniature pigs were fed a hypercaloric atherogenic diet to induce metabolic syndrome. At age 15 months the pigs were treated with 2,000 or 4,000 shock waves (24 kV at 120 shock waves per minute) using an unmodified HM3 lithotripter (Dornier MedTech, Kennesaw, Georgia). Shock waves were targeted to the left kidney upper pole calyx to model treatment that would also expose the pancreatic tail to shock waves. The intravenous glucose tolerance test was done in conscious fasting pigs before lithotripsy, and 1 and 2 months after lithotripsy with blood samples taken for glucose and insulin measurement.Results: Pigs fed the hypercaloric atherogenic diet were obese, dyslipidemic, insulin resistant and glucose intolerant, consistent with metabolic syndrome. Assessments of insulin resistance, glucose tolerance and pancreatic beta cell function from fasting plasma glucose and insulin levels, and the glucose and insulin response profile to the intravenous glucose tolerance test were similar before and after lithotripsy.Conclusions: The metabolic syndrome status of pigs treated with shock wave lithotripsy was unchanged 2 months after kidney treatment with 2,000 high amplitude shock waves or overtreatment with 4,000 high amplitude shock waves. These findings do not support a single shock wave lithotripsy treatment of the kidney as a risk factor for the onset of diabetes mellitus.

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (III)1 Apr 20131825 INTRAVENOUS GLUCOSE TOLERANCE TEST ASSESSMENT OF GLUCOSE-INSULIN KINETICS FOLLOWING TREATMENT OF THE KIDNEY WITH A SUPRA-MAXIMAL DOSE OF SHOCK WAVES IN A PORCINE MODEL OF METABOLIC SYNDROME Rajash Handa, Cynthia Johnson, Bret Connors, Andrew Evan, Mouhamad Alloosh, Michael Sturek, Jessica Mandeville, Ehud Gnessin, and James Lingeman Rajash HandaRajash Handa Indianapolis, IN More articles by this author , Cynthia JohnsonCynthia Johnson Indianapolis, IN More articles by this author , Bret ConnorsBret Connors Indianapolis, IN More articles by this author , Andrew EvanAndrew Evan Indianapolis, IN More articles by this author , Mouhamad AllooshMouhamad Alloosh Indianapolis, IN More articles by this author , Michael SturekMichael Sturek Indianapolis, IN More articles by this author , Jessica MandevilleJessica Mandeville Indianapolis, IN More articles by this author , Ehud GnessinEhud Gnessin Indianapolis, IN More articles by this author , and James LingemanJames Lingeman Indianapolis, IN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2188AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In our continuing efforts to determine whether shock wave lithotripsy (SWL) is a risk factor for the development of diabetes mellitus, we treated the kidney of metabolic syndrome (MetS) pigs with a supra-maximal dose of shock waves (SWs) and assessed the SWL effect on the glucose-insulin kinetic response to an intravenous glucose tolerance test (IVGTT). METHODS Adult female Ossabaw pigs (9-month-old) were fed an excess calorie atherogenic diet to induce MetS. At 15 months of age, the MetS pigs underwent SWL treatment (4000 SWs, 24 kV at 120 SWs/min using the HM-3 lithotripter; n=7). SWs were targeted to the upper pole calyx of the left kidney because of its close association with the tail of the pancreas?a segment rich in insulin containing β-cells. IVGTTs were performed on conscious, fasting MetS pigs before SWL and at 1-month and 2-months post-SWL with frequent blood samples taken for glucose and insulin measurement. RESULTS Pigs fed an excess calorie atherogenic diet developed features of MetS: obesity, dyslipidemia, insulin resistance and glucose intolerance. Fasting levels of plasma glucose and insulin, as well as their response profile to IVGTTs, were similar before and after SWL. Estimates of insulin resistance, glucose tolerance and pancreatic beta cell function derived from the glucose-insulin kinetics calculated from IVGTTs were not significantly altered following SWL. CONCLUSIONS The pig?s MetS status was unchanged following overtreatment of the kidney with 4000 high-energy SWs. These findings do not support a single session of SWL in MetS patients as a risk factor for the onset of diabetes mellitus?at least in the short-term. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e750 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajash Handa Indianapolis, IN More articles by this author Cynthia Johnson Indianapolis, IN More articles by this author Bret Connors Indianapolis, IN More articles by this author Andrew Evan Indianapolis, IN More articles by this author Mouhamad Alloosh Indianapolis, IN More articles by this author Michael Sturek Indianapolis, IN More articles by this author Jessica Mandeville Indianapolis, IN More articles by this author Ehud Gnessin Indianapolis, IN More articles by this author James Lingeman Indianapolis, IN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal I1 Apr 20121537 SHOCK WAVE LITHOTRIPSY DOES NOT INCREASE THE RISK FOR DIABETES IN A PORCINE MODEL OF METABOLIC SYNDROME Rajash Handa, Bret Connors, Cynthia Johnson, Andrew Evan, Mouhamad Alloosh, Michael Sturek, Jessica Mandeville, Ehud Gnessin, and James Lingeman Rajash HandaRajash Handa Indianapolis, IN More articles by this author , Bret ConnorsBret Connors Indianapolis, IN More articles by this author , Cynthia JohnsonCynthia Johnson Indianapolis, IN More articles by this author , Andrew EvanAndrew Evan Indianapolis, IN More articles by this author , Mouhamad AllooshMouhamad Alloosh Indianapolis, IN More articles by this author , Michael SturekMichael Sturek Indianapolis, IN More articles by this author , Jessica MandevilleJessica Mandeville Indianapolis, IN More articles by this author , Ehud GnessinEhud Gnessin Indianapolis, IN More articles by this author , and James LingemanJames Lingeman Indianapolis, IN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1306AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are conflicting clinical data on whether shock wave lithotripsy (SWL) treatment of the kidney increases the risk of developing diabetes mellitus (J Urol 175:1742, 2006; BJUI, 2011 doi:10.1111/j.1464-410X.2011.10291.x). We examined this issue in a porcine model that develops similar features of human metabolic syndrome (“pre-diabetes”), which is a cluster of factors that includes obesity, insulin resistance, impaired glucose tolerance, dyslipidemia and hypertension. METHODS Nine-month-old female Ossabaw pigs were fed an excess calorie atherogenic diet for 6 months to induce pre-diabetes. At 15 months of age, the pigs underwent SWL treatment (2000 SWs, 24 kV at 120 SWs/min using the HM-3 lithotripter). SWs were targeted to the upper pole calyx of the left kidney because of its close association with the tail of the pancreas—a segment rich in insulin containing β-cells. Fasting plasma levels of pancreatic amylase and lipase were measured before SWL and at 1, 7 and 28-days after SWL. Intravenous glucose tolerance tests (IVGTTs) were performed on conscious, fasting pigs before SWL and at 2-months post-SWL with plasma samples taken for glucose and insulin measurement. RESULTS Pigs fed an excess calorie atherogenic diet were obese, glucose intolerant, insulin resistant and dyslipidemic consistent with pre-diabetes. SWL resulted in transient increases in the plasma levels of pancreatic amylase (1 and 7-days post-SWL) and lipase (1-day post-SWL). Fasting levels of plasma glucose and insulin, as well as their response profile to IVGTTs, were similar before and after SWL (see figure). CONCLUSIONS SWL treatment of the upper pole of the left kidney can injure the pancreas as reflected by transient increases in plasma pancreatic amylase and lipase levels. The IVGTT response and metabolic syndrome status of the pigs remained unchanged 2-months after SWL. Therefore, a single SWL treatment does not appear to induce the onset of diabetes or increase the severity of metabolic syndrome under the experimental conditions of this study. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e622 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajash Handa Indianapolis, IN More articles by this author Bret Connors Indianapolis, IN More articles by this author Cynthia Johnson Indianapolis, IN More articles by this author Andrew Evan Indianapolis, IN More articles by this author Mouhamad Alloosh Indianapolis, IN More articles by this author Michael Sturek Indianapolis, IN More articles by this author Jessica Mandeville Indianapolis, IN More articles by this author Ehud Gnessin Indianapolis, IN More articles by this author James Lingeman Indianapolis, IN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

We aimed to review a current management of paediatric nephrolithiasis. The current literature, including our own experience on the treatment of paediatric nephrolithiasis was reviewed by MEDLINE/PubMed search. We have used in our search following keywords: urolithiasis, nephrolithiasis, paediatrics, surgical treatment, conservative management, ESWL, ureteroscopy, and open renal surgery. The search was limited to the English language literature during the period of time from 1990 to 2011. All papers were reviewed independently by all co-authors and only the manuscripts directly related to the reviewed subjects were included into the current review. Due to the high incidence of predisposing factors for urolithiasis in children and high stone recurrence rates, every child with urinary stone should be given a complete metabolic evaluation. Most stones in children can be managed by ESWL and endoscopic techniques. Paediatric stone disease is an important clinical problem in paediatric urology practice. Because of its recurrent nature, every effort should be made to discover the underlying metabolic abnormality so that it can be treated appropriately. Obtaining a stone-free state with interventional management and close follow-up are of utmost importance.