Background: Many of the suggested methods used to study the effect of blast traumatic brain injury (bTBI) are impractical requiring for laboratory settings. Objective: We present a novel method to induce bTBI using Shockwave (SW) lithotripsy in rats with histological, angiographic, and behavioral outcomes over the course of injury and recovery similar to those observed in clinical settings. Material and methods: Anesthetized rats were placed on a lithotripsy machine to deliver 5 SW pulses to the right frontal cortex of each rat's brain. Animals were assigned to three sacrifice endpoints: 24 hrs, 72 hrs, and 168 hrs. Neurological and behavioral assessments (Garcia's test, beam-walking, Rotarod, and elevated-plus-maze) were performed at 3, 6, 24, 72, and 168 hours post-injury. We performed angiography to assess presence of cerebral vasospasm. Damage to brain tissue was assessed by an overall histological severity (OHS). Results: Except for beam-walking, OHS significantly correlated with the other three behavioral outcome. OHS correlated most strongly with anxiety at the baseline and 6 hrs post-injury (rbaseline = -0.75, r6 hrs = 0.85; P < 0.05). Median hemispheric differences for contrast peak values (CPV), obtained from DSA studies, for 24, 72, and 168 hrs endpoints were 3.45%, 3.05% and 0.2%, respectively, with significant differences at 24 vs. 168 hours (p < 0.05) and 72 vs. 168 hours (P < 0.01). The differences in CPV were associated with the study endpoints (P < 0.01). Conclusion: We successfully established a preclinical rat model of bTBI with characteristics similar to those observed in clinical cases. This new method may be useful for future investigations aimed at understanding bTBI pathophysiology.

BACKGROUND AND PURPOSE Three small diameter (<1.5F) stone baskets have recently been introduced. Our objective was to evaluate the stone capture rate of these baskets in an in vitro ureteral model and an in vitro caliceal model using novice, resident, and expert operators. MATERIALS AND METHODS Sacred Heart Medical Halo™ (1.5F), Cook N-Circle(®) Nitinol Tipless Stone Extractor (1.5F), and Boston Scientific OptiFlex(®) (1.3F) stone baskets were tested in an in vitro ureteral and a caliceal model by three novices, three residents, and three experts. The caliceal model consisted of a 7-cm length of 10-mm O.D. plastic tubing with a convex base. Each operator was timed during removal of a 3-mm calculus from each model with three repetitions for each basket. Data were analyzed by analysis of variance single factor tests and t tests assuming unequal variances. RESULTS In the ureteral model, the Halo had the fastest average rate of stone extraction for experts and novices (0:02 ± 0:01 and 0:08 ± 0:04 min, respectively), as well as the overall fastest average stone extraction rate (0:08 ± 0:06 min). No statistical significant differences in extraction times between baskets were identified in the resident group. In the novice group, the Halo stone extraction rate was significantly faster than the OptiFlex (P=0.029). In the expert group, the OptiFlex had statistically significant slower average extraction rates compared with the Halo (P=0.005) and the N-Circle (P=0.017). In the caliceal model, no statistically significant differences were noted. CONCLUSION While no significant differences were noted in extraction times for the caliceal model, the extraction times for the ureteral model were slowest with the OptiFlex basket. Other variables important in selection of the appropriate basket include operator preference, clinical setting, and cost.

INTRODUCTIONStenting is the best approach to manage ureteral extrinsic compression and depends on intraluminal patency, which is mainly determined by cross-sectional stability. We evaluated the resistance to extrinsic compression of the Silhouette Scaffold Device and its ability to simultaneously maintain intraluminal flow.MATERIALS AND METHODSFour 8 F Silhouette stents of different lengths were evaluated for radial compression and intraluminal flow by an MTS Micro Bionix Testing System using Testworks II software. Compression was exerted in 0.2 mm increment cycles until a maximum load cell of 5 N was reached. The Young's modulus, E, was calculated from each trial using engineering stress. Flow rates were compared with the 10.2 F Cook Amplatz. Analysis of variance was used to detect differences between Scaffold stents, and Student's t-test for differences between baseline flow rates. A level of significance of p < 0.05 was used.RESULTSCross-sectional area and E did not differ throughout different length Scaffold stents (average 28,856 +/- 2592; 95% confidence interval 27,447, 30,265; p = 0.426). The inner lumen of the 10.2 F Cook Amplatz was larger by 0.125 mm. Baseline flow rate of the Cook Amplatz was significantly higher than that of the Silhouette Scaffold (1.089 vs. 0.660 mL/second, p = 0.001), but the drop in the flow rate was four times faster for the Amplatz.CONCLUSIONThe resistance of 8 F Silhouette Scaffold Device is extremely higher than that of previously tested stents, and it is uniform along the shaft and does not vary with length. The Cook Amplatz 10.2 F stent has higher flow at baseline and 2 mm compression, but its flow rate drops four times faster than the Silhouette Scaffold.

Introduction: Ureteroscopes have evolved from purely diagnostic tools to key instruments in the management of stone disease and other pathology of the upper urinary tract. Despite these advances, problems related to visibility and maneuverability can hinder the goals of surgical intervention. In this study, we evaluate the capabilities of a modern dual-channel flexible ureteroscope and demonstrate novel techniques afforded by this technology. Using the Cobra dual-channel flexible ureteroscope (Richard Wolf), we performed patient-based case studies of stone basketing and laser lithotripsy in addition to laser excision and extraction of an upper tract renal lesion. A similar simulation-based scenario of stone basketing and fragmentation is also demonstrated. Materials and Methods: The dual-channel scope has two separate 3.3F channels. One is designed as a traditional working channel; the second provides a wheel-based laser advancement device and the option for simultaneous suction or additional flow. During extraction of a 1 cm calculus, we demonstrate the ability to simultaneously use a basket to secure the stone while performing laser lithotripsy. The dualchannel configuration allows the concomitant use of these two tools with good maneuverability and increased flow, providing improved visibility. For removal of an upper tract renal lesion, the basket can be used to put the mass on traction, which allows for improved excision with the laser. The operable improvements from improved flow and comparable deflection characteristics are demonstrated. Results and Conclusions: The single-channel scope has improved upward deflection both empty and with all but the largest single tool with an improved range of 4 to15 degrees. The dual-channel scope has improved downward deflexion across all comparisons and better upward deflexion with the largest tool and when multiple tools are used. Its improvement ranged from 6 to 40 degrees, with its greatest benefit seen in downward deflexion with an average increase of 23.9 degrees of movement. Overall, the deflection angle was comparable to that observed in other studies evaluating modern flexible ureteroscopes and demonstrates that the addition of the second channel should not decrease functional access to areas of the kidney that recent advancements have allowed.1,2 For flow, the individual channels of the dual scope each provide slower flow than the larger single-channel ureteroscope, both empty and with all tested instruments. However, since flow can be provided through a dedicated port in the dual-channel configuration, overall flow can be up to 37 times faster than the single channel (range1.5–37) depending on the configuration of tools used. The dual-channel flexible ureteroscope allows for the simultaneous use of baskets and lasers, providing novel approaches such as stone stabilization and tissue traction to traditional procedures. With the aid of two working-sized channels, increased irrigant flow can be obtained using either one or two working instruments. This has the potential to speed up operative procedures, create more complete resections, and allow greater stone free-rates with improved visibility and handling. No competing financial interests exist. Run time of video: 6 min 49 sec

Introduction: Despite technological advances in endoscopes, stone basket entrapment is still a problem for urologists. Methods to free the basket with laser or shockwave lithotripsy have been published.1–5 Using a simple ex vivo model, we describe and demonstrate preliminary experiments, using readily available instrumentation, that warrant further study for clinical applicability, specifically in those circumstances where a laser is not available to fragment the stone or basket. Materials and Methods: A nitinol flat wire 2.4F, nitinol tipless 1.5F, stainless steel flat wire 3.0F, and stainless steel paired helical 3.0F were used in a silicon tube ureteral model. A 4-mm chrome ball was positioned inside the cage of the bare basket wire and placed in the ureteral model. A flexible ureteroscope or rigid ureteroscope was utilized to reach the entrapped basket in the mock ureter. Three different techniques—reverse guidewire method Tap and Roll, reverse guidewire with torque drive wire method, and 3-prong grasper method—were applied to release the entrapped basket. Results: The reversed guidewire method Tap and Roll (video 1) was successful for both nitinol baskets and the stainless steel paired helical basket. The reversed guidewire with torque drive wire method (video 2) was successful for the nitinol flat wire and stainless steel paired helical basket. The grasper method (video 3) was successful for both the nitinol baskets and the stainless steel paired helical basket. Conclusions: Release of the entrapped stone basket is a challenging situation to the endourologist. We describe some simple methods of disengagement that with further study may be clinically useful, especially in situations where shockwave and laser lithotripsy are not available. All authors have declared that no competing financial interests exist. Runtime of video: 4 mins 13 secs

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal I1 Apr 20101446 IDENTIFICATION OF CONDITIONING FILM COMPONENTS ON INDWELLING URETERAL STENTS AND THEIR ROLE IN BACTERIAL ADHESION Dirk Lange, Chelsea N. Elwood, Adam Crowe, Ricardo Miyaoka, Manoj Monga, and Ben H. Chew Dirk LangeDirk Lange Vancouver, Canada More articles by this author , Chelsea N. ElwoodChelsea N. Elwood Vancouver, Canada More articles by this author , Adam CroweAdam Crowe Vancouver, Canada More articles by this author , Ricardo MiyaokaRicardo Miyaoka Minneapolis, MN More articles by this author , Manoj MongaManoj Monga Minneapolis, MN More articles by this author , and Ben H. ChewBen H. Chew Vancouver, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1160AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A common problem with indwelling ureteral stents is adhesion of bacteria to the device surface. We believe that urinary proteins within a conditioning film form anchor points to which bacteria adhere. We sought to identify these proteins. METHODS Polaris stents (Boston Scientific) and InLay stents (Bard) removed from patients were analyzed for adherent proteins. Stent biofilms were scraped using a sterile scalpel blade and re-suspended in protein solubilization buffer (7M urea, 2M thiourea, 25mM triethylammonium biocarbonate, 0.2% CHAPS and 0.2% SDS). Total protein was determined for each sample via Bradford Assay and 15μg were run on a 12% SDS-Polyacrylamide gel. Protein was extracted from gel pieces via gel trypsin digestion and analyzed using Quadrupole Time of Flight Mass Spectrometry. RESULTS In total, 116 and 99 unique proteins were identified on the Polaris (n=24) and InLay (n=20) stents, respectively. The most common proteins found on both stents are given in the table below, along with the percentage of stents containing them. Significantly less Polaris stents were found to contain Uromodulin (p=0.002) and Fibrinogen gamma chain (p=0.026) than InLay stents, while no significant differences were found for the remaining proteins. Protein InLay Polaris Cytokeratin 1 90% 91% Serum Albumin 85% 91% Hemoglobin subunit beta 80% 62% Uromodulin 80% 42% Fibrinogen (gamma chain) 75% 42% Cytokeratin 10 75% 66% Cytokeratin 9 75% 62% Cytokeratin 2 70% 75% Protein S100A9 60% 42% Fibrinogen (alpha chain) 55% 33% Fibrinogen (beta chain) 55% 46% Hemoglobin (subunit alpha) 50% 58% Cytokeratin 19 40% 50% Vitronectin 40% 42% Apolipoprotein 35% 17% Cytokeratin 13 25% 46% Cytokeratin 8 25% 46% Cytokeratin 7 20% 42% CONCLUSIONS The majority of conditioning film components do not differ between different stents or between patients with the same stent type. Uromodulin normally inhibits bacterial colonization and calcium oxalate crystal formation by binding bacteria and calcium, but in this scenario, it may facilitate stent associated infection and encrustation. Furthermore, the presence of calcium binding proteins such as S100A9 may serve as a nidus for stent encrustation. Of the fifteen most commonly found proteins, the majority are known binding sites for bacteria. We believe that the key to preventing bacterial adhesion and biofilm formation to ureteral devices is preventing the deposition of these bacterial-anchoring proteins. We have taken the first step in identifying these proteins. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e557-e558 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dirk Lange Vancouver, Canada More articles by this author Chelsea N. Elwood Vancouver, Canada More articles by this author Adam Crowe Vancouver, Canada More articles by this author Ricardo Miyaoka Minneapolis, MN More articles by this author Manoj Monga Minneapolis, MN More articles by this author Ben H. Chew Vancouver, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...