You have accessJournal of UrologyCME1 Apr 2023PD20-02 UNDERREPRESENTATION OF RACIAL AND ETHNIC DIVERSITY IN THE LITERATURE INFORMING THE 2022 AMERICAN UROLOGICAL ASSOCIATION/AMERICAN SOCIETY OF RADIATION ONCOLOGY/SOCIETY GUIDELINE ON CLINICALLY LOCALIZED PROSTATE CANCER David Ambinder, Monica He, Pressler Mariel, Parissa Alerasool, Daniel Bassily, Akhil Saji, Evan Spencer, Majid Eshghi, Muhammad Choudhury, and John Phillips David AmbinderDavid Ambinder More articles by this author , Monica HeMonica He More articles by this author , Pressler MarielPressler Mariel More articles by this author , Parissa AlerasoolParissa Alerasool More articles by this author , Daniel BassilyDaniel Bassily More articles by this author , Akhil SajiAkhil Saji More articles by this author , Evan SpencerEvan Spencer More articles by this author , Majid EshghiMajid Eshghi More articles by this author , Muhammad ChoudhuryMuhammad Choudhury More articles by this author , and John PhillipsJohn Phillips More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The relationship between race and prostate cancer is complex. African American patients with prostate cancer are more likely to present with more advanced prostate cancer compared to their white counterparts. This may be associated with genetic differences but are also attributed to socioeconomic status and reduced access to healthcare. It follows that guideline informing data should a) include baseline demographic data including race and ethnicity and b) demographics should include a diverse patient population that is generalizable across racial and ethnic populations. The purpose of our study is to investigate and characterize the demographic representation in the literature that was cited in the 2022 American Urological Association guidelines on clinically localized prostate cancer. METHODS: Research that was cited by the guideline were reviewed based on a set of inclusion and exclusion criteria. Studies included were based in the United States and included patient demographics and patient ethnicity and race. RESULTS: We reviewed the 297 studies cited in the AUA guideline. After excluding 166 studies based on our predetermined exclusion criteria, we included 131 studies in our further analysis. Of these, 68 studies were based exclusively in the U.S. Of the 68 U.S.-based studies, 35 (51.5%) reported racial demographic data. Of these, 9 (25.7%) were randomized controlled trials, 18 were retrospective cohort studies (51.4%), 11 were prospective cohort studies (31.4%), and the 1 remaining was a cross-sectional study (4%). Of these studies that reported racial data, 21 (60.0%) reported race as either white/Caucasian, black/African American, or other/unknown. Overall of these studies that included race, 81.7% of patients were white/Caucasian, 9.9% were black/African American, and 8.4% were other/unknown including Hispanic and Asian. CONCLUSIONS: The vast majority of the research used in the establishment of the most recent guidelines on clinically localized prostate cancer did not include patient racial demographics. In the studies that included race, the majority only provided information on white/Caucasian and black/African American patients and did not capture other racial categories such as Hispanic or Asian. Overall, white/Caucasian patients were greatly overrepresented in relation to black/African American patients while Hispanic and Asian patients were underrepresented or categorically excluded. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e583 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Ambinder More articles by this author Monica He More articles by this author Pressler Mariel More articles by this author Parissa Alerasool More articles by this author Daniel Bassily More articles by this author Akhil Saji More articles by this author Evan Spencer More articles by this author Majid Eshghi More articles by this author Muhammad Choudhury More articles by this author John Phillips More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 May 2022MP40-18 OFFICE-BASED FLEXIBLE URETEROSCOPY FOR ACTIVE SURVEILLANCE FOR UPPER TRACT UROTHELIAL CARCINOMA FOLLOWING NEPHRON-SPARING SURGERY Nathan Colin Wong, Sameh Naim, Jonathan Wagmeister, Ariel Schulman, Bertie Zhang, John Phillips, Muhammad Choudhury, and Majid Eshghi Nathan Colin WongNathan Colin Wong More articles by this author , Sameh NaimSameh Naim More articles by this author , Jonathan WagmeisterJonathan Wagmeister More articles by this author , Ariel SchulmanAriel Schulman More articles by this author , Bertie ZhangBertie Zhang More articles by this author , John PhillipsJohn Phillips More articles by this author , Muhammad ChoudhuryMuhammad Choudhury More articles by this author , and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002600.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephron-sparing surgery (NSS) for upper tract urothelial carcinoma (UTUC) offers select patients renal preservation but demands close surveillance including routine ureteroscopy that typically require general anesthesia. We report feasibility and our experience in utilizing ureteric orifice meatotomy to facilitate office-based flexible ureteroscopy under local anesthesia. METHODS: A retrospective chart review was conducted including consecutive patients who underwent NSS of UTUC at our tertiary center. Patients underwent ureteric orifice meatotomy followed by attempted flexible ureteroscopy in the office setting under local anesthesia with transurethral 2% lidocaine jelly. Otherwise, patients underwent routine ureteroscopic surveillance under general anesthesia and all patients underwent routine cross-sectional imaging including 3-D ‘virtual ureteroscopy’ by reconstruction of CT urography to evaluate for disease recurrence. RESULTS: A total of 16 patients (7 male; 9 female) with UTUC were treated with NSS – 9/16 (56%) were initially managed ureteroscopically and 7/16 (44%) percutaneously. Median age at diagnosis was 79 (IQR 71.5, 81.5) and median follow-up was 3 years (IQR 2, 3.5). The majority of patients had high grade disease (75%) and tumor location was typically renal pelvis (10/16; 63%) followed by distal ureter (4), mid ureter (1) and proximal ureter (1). A total of 3/16 (18%) had history of contralateral UTUC, 3/16 (18.8%) had solitary kidney and 10/16 (62%) had concomitant bladder cancer. A total of 10/16 patients (63%) who underwent ureteric orifice meatotomy tolerated flexible ureteroscopy in an office-based setting under local anesthesia, the rest required general anesthesia. Overall, 8/16 (50%) had disease recurrence, typically at the location of their initial site of disease. Of the 10 patients with renal pelvic disease, 6 (60%) recurred in the renal pelvis. Of the 6 patients with ureteral disease, 2 (33%) recurred in the ureter. Of those who recurred, 4 (50%) were successfully managed with ongoing endoscopic therapy and 4 (50%) ultimately underwent radical nephroureterectomy, 3 of which had disease upstaging on final pathology. There were 2 deaths related to comorbidities, both of who had a solitary kidney. There were no UTUC-related deaths. CONCLUSIONS: In select patients with UTUC who undergo NSS, ureteric orifice meatotomy is feasible and allows the majority of patients to tolerate office based flexible ureteroscopy under local anesthesia without compromising oncologic outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e682 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Colin Wong More articles by this author Sameh Naim More articles by this author Jonathan Wagmeister More articles by this author Ariel Schulman More articles by this author Bertie Zhang More articles by this author John Phillips More articles by this author Muhammad Choudhury More articles by this author Majid Eshghi More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To characterize the rates of endovascular stapler complications during hilar ligation in minimally invasive radical nephrectomy over the last 10 years. MATERIAL AND METHODS We reviewed the Food and Drug Administration Manufacturer and User Facility Device Experience database from January 1, 2009 to August 1, 2019. Staplers were categorized according to type, namely Ethicon Inc. endocutters (Johnson & Johnson, New Brunswick NJ); Endo-GIA (Medtronic, Minneapolis MN); and Endo-TA (Medtronic, Minneapolis MN). RESULTS There were 383 cases of complications involving staplers, 63% with Ethicon endocutters; 28% with GIA; and 9% with TA. 22 deaths (5.7% of total complications) were attributed to staplers. No deaths or reoperations occurred due to TA staplers. TA staplers were also associated with a reduced incidence of conversion to open as compared to Ethicon and GIA staplers. Apart from one device, manufacturer evaluation of returned devices either showed no abnormalities or attributed fault to improper use of staplers. DISCUSSION We characterized stapler complications during a 10-year period for minimally invasive radical nephrectomy. No deaths or reoperations occurred due to TA staplers, perhaps due to cutting and stapling occurring in separate steps. Based on manufacturer evaluation attributing stapling malfunctions to human errors, training of operating room staff on proper use of these devices is critical to prevent potentially significant complications from occurring. (C) 2021 Elsevier Inc.

OBJECTIVE To assess interviewing applicant perceptions of a virtual urology residency interview in the setting of changes mandated by COVID-19 and to determine applicant preference for virtual or in person interviews. Applicant perceptions of multiple interview components were queried to identify program specific and interview modality specific strengths or weaknesses in the 2020 to 2021 Urology Match. METHODS A 12 question multiple choice and free text survey was emailed to 66 virtually interviewed applicants for open residency positions at a metropolitan training program after conclusion of interviews. Items of interest included interview type preference, overall interview impression, and recommendations for improvement. RESULTS A total of 50 of 66 (76%) applicants completed the survey corresponding to approximately 11% of the 2020 national urology applicant pool. A total of 49 of 50 (96%) respondents assessed faculty interaction and the virtual platform positively. A total of 38 of 50 (76%) was satisfied with their resident interaction and 32 of 50 (64%) applicants stated they were able to satisfactorily evaluate the site and program. Ultimately, 39 of 50 (78%) respondents would have preferred an in person interview to our virtual interview. Respondents cited challenges in assessing program culture and program physical site virtually. CONCLUSION The majority of survey respondents indicated a preference for in person interviews. A smaller proportion of applicants preferred virtual interviews citing their convenience and lower cost. Efforts to improve the virtual interview experience may focus on improving applicant-resident interaction and remote site assessment. (C) 2021 Elsevier Inc.

Background: Following our hypothesis that oxidative stress might play a primary role in renal ischemia/reperfusion injury (RIRI), we investigated if ethyl pyruvate (EPy) with potent antioxidant activity might prevent or alleviate RIRI induced in rats. Methods: Sprague-Dawley rats were randomly divided into four groups: (A) Sham, (B) renal ischemia/reperfusion (RIR), (C) RIR with EPy supplement (RIR+EPy), and (D) RIR with Mann supplement (RIR+Mann). Mannitol (Mann), a preoperative agent being clinically used, was tested for comparison with EPy. Rats were subjected to 40-min ischemia, followed by 24-h reperfusion. Either EPy or Mann was given to rats 30 min prior to ischemia and immediately before the reperfusion period. Results: The RIR and RIR+Mann groups showed palpable kidney injuries with the ~5-fold elevated blood urea nitrogen (BUN) and creatinine (Cr) levels, indicating renal dysfunction. However, the kidneys in the RIR+EPy group appeared merely normal (similar to the Sham’s) with the basal BUN/Cr levels, indicating normal renal function. No effects on histology, BUN or Cr were yet seen with Mann. Moreover, specific kidney injury markers were up-regulated and oxidative stress was also ~2.1-fold severer in the RIR group, whereas little changes in those markers and oxidative stress were seen with EPy supplement (RIR+EPy). Conclusions: Although oxidative stress feasibly plays a key role in RIRI, EPy with antioxidant activity is capable of protecting the kidneys from such an assault. Thus, EPy (not Mann) should be considered as an effective perioperative renoprotective agent that could be used clinically.

cystoscope and/or ureteroscope in the of fi ce every 3-6 months for the fi rst two years and annually thereafter. RESULTS: 10 patients with average age of 77 years, 40% of whom were male, underwent ureteral meatotomy between 2015 and 2021. 90% of tumors were either in the distal ureter or UPJ/renal pelvis. Average tumor size was 1.6 cm. 70% of tumors were low grade on biopsy. 3 patients had concomitant bladder cancer. There were no complications associated with chemotherapy instillation. Of the patients who had only upper tract disease, none developed a new recurrence in the bladder. CONCLUSIONS: We describe a novel anterior intramural ure-teral incision technique in patients with ureteral tumors managed endoscopically that reliably allows for both chemotherapy administration and upper tract surveillance in an of fi ce setting.

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-01 EXTENDED URETERAL MEATOTOMY FOR OUTPATIENT CHEMOTHERAPY ADMINISTRATION AND URETEROSCOPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA Nikhil Gopal, Sameh Naim, Bertie Zhang, John Phillips, and Majid Eshghi Nikhil GopalNikhil Gopal More articles by this author , Sameh NaimSameh Naim More articles by this author , Bertie ZhangBertie Zhang More articles by this author , John PhillipsJohn Phillips More articles by this author , and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with ureteral tumors managed endoscopically often benefit from adjuvant immuno-chemotherapy and require interval upper tract surveillance with ureteroscopy. However, both often require general anesthesia, which can be problematic for a predominantly elderly population with multiple co-morbidities. Here we describe an endoscopic technique of ureteral meatotomy to not only predictably allow for reflux of intravesical agents through the ureter, but also to allow upper tract endoscopy to be performed in the office setting. METHODS: From 2015-2021, we performed ureteral meatotomy on 10 patients. All patients who underwent this procedure had upper tract urothelial tumors deemed suitable for primary endoscopic management, based on patient’s clinical characteristics; tumor number; size; location; and/or biopsy grade.Under general anesthesia, a 10 F dual lumen ureteral catheter or 6-12 F Nottingham dilator was inserted into the distal ureter in order to allow for alignment of the ureter towards the bladder neck and to ensure the orifice is incised in the correct direction. Using either a Holmium laser or Collin’s knife, a full-thickness 2 cm incision was made on the distal intramural ureter at the 12 o’clock position, until the anterior portion of the catheter was visualized. Intraoperative cystogram was used to confirm ureteral reflux. A double J stent was then left in place for 3 weeks for mucosal healing and reshaping of the distal ureteral segment. Postoperatively, patients underwent 6 cycles of mitomycin, either via indwelling Foley catheter or nephrostomy tube. Lower and upper urinary tract surveillance was performed using flexible cystoscope and/or ureteroscope in the office every 3-6 months for the first two years and annually thereafter. RESULTS: 10 patients with average age of 77 years, 40% of whom were male, underwent ureteral meatotomy between 2015 and 2021. 90% of tumors were either in the distal ureter or UPJ/renal pelvis. Average tumor size was 1.6 cm. 70% of tumors were low grade on biopsy. 3 patients had concomitant bladder cancer. There were no complications associated with chemotherapy instillation. Of the patients who had only upper tract disease, none developed a new recurrence in the bladder. CONCLUSIONS: We describe a novel anterior intramural ureteral incision technique in patients with ureteral tumors managed endoscopically that reliably allows for both chemotherapy administration and upper tract surveillance in an office setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1078-e1078 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikhil Gopal More articles by this author Sameh Naim More articles by this author Bertie Zhang More articles by this author John Phillips More articles by this author Majid Eshghi More articles by this author Expand All Advertisement Loading ...

INTRODUCTION AND OBJECTIVE: Primary hyperoxaluria (PH), a rare inborn error of metabolism resulting in liver oxalate over-production, has signi fi cant clinical rami fi cations potentially affecting multiple organs including the kidneys, heart, eyes, bones/joints

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (MP04)1 Apr 2020MP04-14 COMPLICATIONS OF ENDOVASCULAR STAPLING DEVICES DURING MINIMALLY INVASIVE RADICAL NEPHRECTOMY: AN UPDATED REVIEW OF THE FOOD AND DRUG ADMINISTRATION DATABASE FROM 2009-2019 Nikhil Gopal* and Majid Eshghi Nikhil Gopal*Nikhil Gopal* More articles by this author and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000818.014AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: With the advent of minimally invasive surgery, ligation of major renal vessels during radical nephrectomy is accomplished using endovascular staples as opposed to sutures and clips. However, despite its rampant use, there remains little recent evidence characterizing staple complications. We used a publicly available database on device complications to characterize rates of staple complications within the last 10 years. METHODS: We reviewed the Food and Drug Administration Manufacturer and Facility Device Experience (MAUDE) database for reports dating from January 1, 2009 to August 1, 2019 using search terms “stapler laparoscopic nephrectomy” and “stapler robotic nephrectomy”. Endovascular staples were categorized according to type, namely Ethicon endocutters (i.e., Endopath®); Covidien GIA™; and Covidien TA™ staplers. RESULTS: There were 386 total complications involving endovascular staples, 241 (63%) with Ethicon endocutters; 107 (28%) with GIA; and 36 (9%) with TA. There were 13 deaths due to Ethicon endocutters (7% of total complications) and 6 deaths due to GIA staplers (5.8% of total complications). No deaths occurred with TA staples. Deaths occurred due to stapler misfiring on renal artery. There were 17 cases (16%) of conversion to open with GIA staplers, as compared to 4 cases (11%) with TA staplers and 47 cases (20%) with Ethicon endocutters. Reoperation was required in 4 cases (4%) involving GIA staplers and 5 cases (5%) involving Ethicon endocutters. TA staplers were not associated with any reoperations. 13 cases (12%) of GIA stapler complications resulted in significant blood loss as compared to 3 cases (8%) with TA and 13 cases (5%) with Ethicon endocutters. Relatively, more GIA complications were associated with major blood loss compared with Ethicon endocutters (p=0.02). Manufacturer evaluation of returned devices either showed no abnormalities or attributed fault to improper use of the device. CONCLUSIONS: Despite the field of urology embracing endovascular staples for minimally invasive radical nephrectomy, even in recent years, these devices can cause devastating complications. No deaths or reoperations occurred with TA staplers, perhaps due to ligation and stapling occurring in separate steps. Adequate training of operating room staff on proper use of these devices is critical to prevent significant complications from occurring. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e37-e37 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikhil Gopal* More articles by this author Majid Eshghi More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION AND OBJECTIVE: The standard of care for upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy; however, certain patient populations such patients with significant medical comorbidities precluding surgical intervention, bilateral foci of UTUC or requirement for nephrotoxic chemotherapy for non-urologic malignancy may benefit from a conservative treatment approach. Ureteroscopic resection of small upper tract tumors has been reported; however, this technique has not been shown to be effective for large tumors. This video demonstrates an endoscopic surgical approach for management of large bulky upper tract tumors. METHODS: The location and size of the tumor dictate which instruments are required. For smaller tumors involving the renal calyx or infundibulum we utilized a 19 Fr miniscope with a 15.5 bipolar mini resectoscope. For larger tumors involving the renal pelvis we use a 24 or 27 standard transurethral resectoscope. Debulking of the ureteropelvic junction should be done with cold cup forceps to avoid thermal injury and prevent future obstruction secondary to ureteral stricture. RESULTS: At our institution, we have completed 22 such cases over 16 years. We have not observed any upstaging of upper tract disease after resection on routine surveillance. Two mortalities have been reported; however, neither was due to progression of urothelial malignancy. CONCLUSIONS: Patients with contraindications to radical nephroureteretomy may benefit from conservative management utilizing a combination of percutaneous endoscopic resection and intracavitary chemotherapy. Source of Funding: None

Background: Oxidative stress (OXS) is believed to play a significant role in the development of nephrolithiasis. This possibility was tested by a medicinal mushroom extract, PE, with antioxidant activity capable of diminishing OXS. We examined whether PE would protect renal cells from OXS in vitro and prevent the calcium oxalate (CaOx) crystal formation in a rat model (in vivo). Methods: Antioxidant activity of PE was assessed if it could reduce OXS exerted by hydrogen peroxide (H2O2), a typical OXS inducer, in renal epithelial MDCK cells. Whether PE may also prevent/reduce the CaOx crystal formation, which was chemically induced by orally giving the rats ethylene glycol (EG), was examined. Results: The reduction in cell viability with elevated OXS by H2O2 was significantly prevented with PE in MDCK cells. Such elevated OXS was also diminished with PE, resulting in high cell viability. In the rat study, numerous CaOx crystals were found in the rats received EG only in 2 weeks, whereas PE significantly (similar to 50%) reduced such EG-induced crystal deposits. Moreover, a similar to 1.2-fold increase in OXS with EG in the rat kidney was yet reduced by similar to 60% with PE, demonstrating antioxidant activity of PE. Conclusions: The mushroom extract PE shows its antioxidant activity against H2O2-exerted OXS in MDCK cells. PE is also capable of preventing the CaOx crystal formation (similar to 50%) in the rat kidneys, plausibly through its antioxidant activity. Therefore, PE could be a promising natural antioxidant, capable of protecting renal cells from OXS and potentially preventing the CaOx crystal formation.

You have accessJournal of UrologyStone Disease: Surgical Therapy III (MP23)1 Apr 2019MP23-11 THE CONTINUOUS RENAL PELVIC DECOMPRESSION TECHNIQUE DURING URETEROSCOPY Jonathan Wagmaister*, Neel H. Patel, Cristina Fox, Sean Fullerton, John L. Phillips, and Majid Eshghi Jonathan Wagmaister*Jonathan Wagmaister* More articles by this author , Neel H. PatelNeel H. Patel More articles by this author , Cristina FoxCristina Fox More articles by this author , Sean FullertonSean Fullerton More articles by this author , John L. PhillipsJohn L. Phillips More articles by this author , and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555617.05303.ceAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Ureteroscopy for renal and ureteral stone disease is a low-risk procedure with minimal risks of serious complications, however, the rate of postoperative sepsis can be as high as 5%. High Renal Pelvic Pressure (RPP) with subsequent pyelovenous backflow and bacterial translocation into the renal parenchyma is considered one of the most significant risk factors. In this study, we present a technique in which the renal pelvis is continuously decompressed during ureteroscopy as a proposed method for reducing the operative RPP and the postoperative septic complications. METHODS: Technique: A flexible ureteroscope is safely positioned in the ureter and a parallel safety guidewire is exchanged for a 5 or a 6 French open-ended catheter, through which the renal pelvis can be passively or actively decompressed. Additionally, contrast medium can be injected for a simultaneous retrograde pyelogram, if indicated. VALIDATION STUDY: We have retrospectively reviewed the charts of our ureteroscopic procedures during the last 8 years in which the Continuous Renal Pelvic Decompression was implemented. The results were compared with the database of one of our satellite institutions, where the procedures were done under a regular technique. Both institutions implemented the same guideline-based perioperative prophylactic antibiotic protocols. Additionally, connecting the Arterial-line manometer to the ureteroscope, we have measured the RPP during our procedures. RESULTS: From 2010 to 2018 we have performed 721 ureteroscopic procedures with continuous renal decompression. No postoperative septic events were seen in any of these patients. In contrast, of 345 ureteroscopies performed in our satellite institution from 2010 to 2015, 15 (4.3%) ureteroscopy-related septic events were identified (p< 0.05). The RPP typically dropped from 140 to 60 mmHg range under continuous decompression. CONCLUSIONS: The Continuous Renal Pelvic Decompression technique can contribute to reduce perioperative ureteroscopic infectious complications, allowing simultaneous retrograde contrast studies during lithotripsy. Additionally, it serves a practical way to actively decompress the collecting system, eliminating “snow-storm effect” and improving visibility, thus, potentially decreasing operating time. Source of Funding: None Valhalla, NY© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e329-e329 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Wagmaister* More articles by this author Neel H. Patel More articles by this author Cristina Fox More articles by this author Sean Fullerton More articles by this author John L. Phillips More articles by this author Majid Eshghi More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Hypothesizing that oxidative stress (OXS) could be a key pathogenic factor for the incidence of chronic kidney disease (CKD), we investigated if the Poria mushroom extract, PE, with possible antioxidant activity, would prevent the incidence of CKD in rats. Materials and Methods: Antioxidant activity of PE was examined against OXS induced by hydrogen peroxide (H2O2) in renal LLC-PK1 cells. Whether PE could prevent the development of CKD in the rat kidneys, mediated through adenine (ADN)-induced OXS, was also examined. After 2 weeks, blood and kidney specimens were collected from rats for blood, histopathologic, and biochemical analyses. Results: Although H2O2-induced OXS led to a significant cell viability reduction in LLC-PK1 cells, PE significantly diminished OXS and sustained high (~70%) cell viability. In rats, ADN-given rats showed typical renal dysfunction with palpable kidney damage; however, PE supplement improved renal function with better histology. A ~2.2-fold increased OXS level was also seen in ADN-given rats but it was reduced by ~27% with PE supplement. Moreover, analysis of kidney injury biomarkers further confirmed extended kidney damage by ADN. Nevertheless, PE effectively maintained the natural status of those markers, protecting the rat kidneys. Conclusions: OXS is indeed harmful to renal cells in vitro and could even lead to ADN-induced CKD in vivo. However, PE appears to have antioxidant activity capable of protecting renal cells and the rat kidneys from such detrimental OXS. Therefore, it is rather possible that PE could be a natural antioxidant with prophylactic effect against OXS-induced CKD.

Introduction: The widespread use of diagnostic and therapeutic ionizing radiation raises concerns regarding excessive occupational and patient exposure. In this study, we test a novel fluoroscopic technique that has the potential to minimize radiation dose during urologic procedures. Materials and Methods: A prospective evaluation of all patients undergoing endoscopic urologic procedures in our institution was conducted. A "two-point technique (TPT)" is described in which the fluoroscope image intensifier (c-arm) is shifted between caudal and cephalad set points of the operative field. We wished to determine whether patient radiation exposure was lower with TPT than with a non-structured conventional technique, referred to as the cognitive fluoroscopic technique (CFT), in which the manipulation of the c-arm was at the discretion of the user. We obtained all clinical, radiographic, and fluoroscopic data of patients in the study period and used unpaired nonparametric statistical analysis of univariates entered stepwise into a logistic regression model. Results: A total of 106 endoscopic urologic procedures from January 2016 to November 2018 were reviewed. Forty-four (41.5%) cases were performed using TPT and 62 (58.5%) using CFT. The mean fluoroscopy time of TPT vs CFT was 71.1 (+/- 60.8) seconds vs 104.5 (+/- 91.6) seconds, respectively (p = 0.04), and the mean radiation dose on TPT vs CFT was 11.6 (+/- 10.6) mGy vs 20.3 (+/- 24.3) mGy, respectively (p = 0.03). TPT was an independent predictor of reduced operative room (OR) time and fluoro time (p < 0.05), while body mass index, age, and operator were not. Conclusion: The "TPT" helps reducing radiation dose and fluoroscopic time during endoscopic urologic procedures. The TPT is useful to lower radiation exposure to patients and OR staff.

Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is a complex multistep surgery that has shown a steady increase in use for the past decade in the United States. We sought to evaluate the trends and factors associated with PCNL usage across New York State (NYS). Our goal was to characterize patient demographics and socioeconomic factors across high-, medium-, and low-volume institutions. Materials and Methods: We searched the NYS, Statewide Planning and Research Cooperative System (SPARCS) database from 2006 to 2014 using ICD-9 Procedure Codes 55.04 (percutaneous nephrostomy with fragmentation) for all hospital discharges. Patient demographics including age, gender, race, insurance status, and length of hospital stay were obtained. We characterized each hospital as a low-, medium-, or high-volume center by year. Patient and hospital demographics were compared and reported using chi-square analysis and Student's t-test for categorical and continuous variables, respectively, with statistical significance as a p-value of Results: We identified a total of 4576 procedures performed from 2006 to 2014 at a total of 77 hospitals in NYS (Table 1). Total PCNL volume performed across all NYS hospitals increased in the past decade, with the greatest number of procedures performed in 2012 to 2013. Low-volume institutions were more likely to provide care to minority populations (21.4% vs 17.3%, p < 0.001) and those with Medicaid (25.5% vs 21.5%, p < 0.001). High-volume institutions provided care to patients with private insurance (42.1% vs 34.0%, p < 0.001) and had a shorter length of stay (3.3 days vs 4.1 days, p < 0.001). Conclusion: Our data provide insight into the patient demographics of those treated at high-, medium-, and low-volume hospitals for PCNL across NYS. Significant differences in race, insurance status, and length of stay were noted between low- and high-volume institutions, indicating that racial and socioeconomic factors play a role in access to care at high-volume centers.

Background: Secondary malignancies of the ureter are uncommon. We report the diagnosis and management of metastatic colon cancer to the bifurcation of a bifid ureter. Case Presentation: A 59-year-old man presented with diffuse metastasis with right hydronephrosis in both renal moieties of a partially duplicated system and an enhancing lesion within the proximal common ureter. Ureteral biopsy was positive for colorectal adenocarcinoma. The patient was subsequently started on palliative chemoradiation. Conclusion: The ureter is a rare location for hematogenous/lymphatic metastases. When a ureteral mass is present on imaging, ureteroscopy should be performed to characterize the extent of tumor and to rule out secondary malignancy.