To report the results of a clinical audit conducted by the British Association of Urological Surgeons (BAUS) of ureteric stone care pathways, with results reported with reference to national quality standards. The BAUS conducted a clinical audit of all patients presenting as an emergency to 107 hospitals in England during November 2020 with ureteric stones. All patients were followed up until 31 March 2021 and the inpatient and outpatient management received was recorded. Data for 2192 patients across 117 units were submitted. The median (interquartile range [IQR]) number of patients per unit was 16 (9–27); 70% of patients were male and the median (IQR) patient age was 46 (34–59) years. Initial management was conservative treatment for 70% of patients. Overall, primary shockwave lithotripsy was performed in 34% of patients and primary ureteroscopy in 23% of cases when surgical intervention was required to treat the stone. However, 40% of patients in whom active intervention was appropriate underwent placement of a temporizing ureteric stent rather than undergo definitive surgical intervention at the outset. Female patients were less likely to have a computed tomography (CT) scan of the kidneys, ureters and bladder performed within 24 h of presentation (13% vs 7.3% for men [chi-squared P = 0.01]) and to be given correct analgesia (66% vs 73% for men [chi-squared P = 0.03]). Patients aged 60 years or older were also significantly less likely to be offered nonsteroidal anti-inflammatory drug analgesia appropriately. In total, 87% of patients had their calcium measured within the last 2 years and 73% of patients had evidence of being offered stone prevention diet and fluid advice. The audit demonstrates that the National Institute of Health and Care Excellence Quality Standards are both measurable and achievable. However, there was considerable variation in the delivery of these standards, including with regard to sex and age, highlighting inequalities for patient care across the UK.

ObjectivesTo report the results of a clinical audit conducted by the British Association of Urological Surgeons (BAUS) of ureteric stone care pathways, with results reported with reference to national quality standards.Patients and MethodsThe BAUS conducted a clinical audit of all patients presenting as an emergency to 107 hospitals in England during November 2020 with ureteric stones. All patients were followed up until 31 March 2021 and the inpatient and outpatient management received was recorded.ResultsData for 2192 patients across 117 units were submitted. The median (interquartile range [IQR]) number of patients per unit was 16 (9–27); 70% of patients were male and the median (IQR) patient age was 46 (34–59) years. Initial management was conservative treatment for 70% of patients. Overall, primary shockwave lithotripsy was performed in 34% of patients and primary ureteroscopy in 23% of cases when surgical intervention was required to treat the stone. However, 40% of patients in whom active intervention was appropriate underwent placement of a temporizing ureteric stent rather than undergo definitive surgical intervention at the outset. Female patients were less likely to have a computed tomography (CT) scan of the kidneys, ureters and bladder performed within 24 h of presentation (13% vs 7.3% for men [chi‐squared P = 0.01]) and to be given correct analgesia (66% vs 73% for men [chi‐squared P = 0.03]). Patients aged 60 years or older were also significantly less likely to be offered nonsteroidal anti‐inflammatory drug analgesia appropriately. In total, 87% of patients had their calcium measured within the last 2 years and 73% of patients had evidence of being offered stone prevention diet and fluid advice.ConclusionsThe audit demonstrates that the National Institute of Health and Care Excellence Quality Standards are both measurable and achievable. However, there was considerable variation in the delivery of these standards, including with regard to sex and age, highlighting inequalities for patient care across the UK.

OBJECTIVES:To determine the preoperative assessment and perioperative outcomes of men undergoing bladder outlet obstruction (BOO) surgery in the UK.PATIENTS AND METHODS:A retrospective cohort study was conducted of all men undergoing BOO surgery in 105 UK hospitals over a 1-month period. The study included 1456 men, of whom 42% were catheter dependent prior to undergoing surgery.RESULTS:There was no evidence that a frequency-volume chart or urinary symptom questionnaire had been completed in 73% or 50% of men, respectively in the non-catheter-dependent group. Bipolar transurethral resection of the prostate (TURP) was the most common BOO surgical procedure performed (38%). Monopolar TURP was the next most prevalent modality (23%); however, minimally invasive BOO surgical procedures combined accounted for 17% of all procedures performed. Of the cohort 5% of men had complications within 30 days of surgery, only 1% had Clavien-Dindo Grade ≥III complications. Less than 1% of the cohort received a blood transfusion after BOO surgery and 2% were re-admitted to hospital after their BOO surgery. In total only 4% of the whole cohort were catheter dependent after BOO surgery. Pre- and postoperative paired International Prostate Symptom Score scores reviewed suggest that minimally invasive surgical procedures achieved comparable levels of improvement in both symptoms and bother at 3 months postoperatively in men who were not catheter dependent preoperatively.CONCLUSIONS:There has been a substantial shift in the available choice of procedure for BOO surgery around the UK in recent years. However, men can be reassured that overall BOO surgery treatments are safe and effective. Evidence of adherence to guidelines in the preoperative assessment of men with lower urinary tract symptoms undergoing surgery was poorly documented and must be improved.

Objectives To compare the total cost of a treatment strategy starting with ureteroscopy (URS) vs a strategy starting with extracorporeal shockwave lithotripsy (ESWL). Methods For ureteric stones of Results The URS strategy was more costly overall than the ESWL strategy (incremental cost of £2387 [pounds sterling]). Sensitivity analysis varying the initial effectiveness of ESWL treatment (between the base case value of 82% and 40%) showed that URS would still be a more costly strategy even if the initial session of ESWL only had a success probability of 40%. A two-way sensitivity analysis as part of the exploratory QALY work showed that ESWL would have to have very low effectiveness and people would have to wait for further treatment for many weeks (following a failed ESWL treatment) for there to be feasible QoL gains to justify the additional cost of the URS strategy. Conclusions ESWL is less effective at initial stone clearance and therefore requires more ancillary interventions than URS. However, the magnitude of the difference in costs means URS is unlikely to be cost effective intervention at a population level for first-line treatment, implying ESWL should be the first choice treatment.

ObjectivesTo compare the total cost of a treatment strategy starting with ureteroscopy (URS) vs a strategy starting with extracorporeal shockwave lithotripsy (ESWL).MethodsFor ureteric stones of <10 mm, URS or ESWL are the main treatment options that are considered. Although the interventions differ, the goal of the interventions is to achieve a stone‐free status. A systematic review and meta‐analysis undertaken as part of the National Institute for Health and Care Excellence (NICE) guideline on ‘Renal and ureteric stones: assessment and management’ identified URS as more effective, in terms of getting people stone free, but has a higher probability of re‐admission and adverse events (AEs) that contributes to downstream resource use. ESWL is initially less costly, but lower effectiveness means a greater need for repeat or ancillary procedures in order to get a patient stone free. Given these trade‐offs between benefits and costs, a cost analysis of URS and ESWL was undertaken as part of the NICE guideline, using evidence from the literature of effectiveness, re‐admission and AEs. The NICE guideline meta‐analysis showed a lot of heterogeneity and differences in how outcomes were reported between studies. The costing analysis, therefore only used studies where: (i) patients were rendered stone free, and (ii) where effectiveness, was based on the first‐line (initial) procedures. Exploratory quality adjusted life year (QALY) work was also undertaken to identify the QALY and quality of life (QoL) differences required for the most expensive intervention to be cost effective, based on the assumption that the difference in effectiveness between the initial procedures would be the main source of the QALY gain between the two strategies.ResultsThe URS strategy was more costly overall than the ESWL strategy (incremental cost of £2387 [pounds sterling]). Sensitivity analysis varying the initial effectiveness of ESWL treatment (between the base case value of 82% and 40%) showed that URS would still be a more costly strategy even if the initial session of ESWL only had a success probability of 40%. A two‐way sensitivity analysis as part of the exploratory QALY work showed that ESWL would have to have very low effectiveness and people would have to wait for further treatment for many weeks (following a failed ESWL treatment) for there to be feasible QoL gains to justify the additional cost of the URS strategy.ConclusionsESWL is less effective at initial stone clearance and therefore requires more ancillary interventions than URS. However, the magnitude of the difference in costs means URS is unlikely to be cost effective intervention at a population level for first‐line treatment, implying ESWL should be the first choice treatment.

Although urinary tract infections occur predominantly in women, men also suffer. Some features are similar to both genders, but certain anatomical sites, risk factors and treatment are unique to men. These are explored in this review of the commonly encountered urological infections in men.

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2016MP33-10 PCNL IN THE UNITED KINGDOM: TRENDS IN 5000 CASES FROM BAUS PCNL REGISTRY William Finch, Robert Calvert, Sarah Fowler, James Armitage, Jonathan Glass, John Withington, Oliver Wiseman, Stuart Irving, and Neil Burgess William FinchWilliam Finch More articles by this author , Robert CalvertRobert Calvert More articles by this author , Sarah FowlerSarah Fowler More articles by this author , James ArmitageJames Armitage More articles by this author , Jonathan GlassJonathan Glass More articles by this author , John WithingtonJohn Withington More articles by this author , Oliver WisemanOliver Wiseman More articles by this author , Stuart IrvingStuart Irving More articles by this author , and Neil BurgessNeil Burgess More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1367AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PCNL continues to be used for the management of large upper tract renal stones. BAUS developed an online data registry in January 2010 that now includes >5000 procedures. We evaluate current practice, outcomes and trends in PCNL compared with the initial 1000 procedures. METHODS The BAUS PCNL registry was analyzed between 2010 and 2015 for patient and procedural data. HES data for PCNL was evaluated to indicate trends in surgeons reporting of data. RESULTS 5191 PCNL procedures were compared with a previous analysis of 1028 PCNLs in 2011. The majority of PCNL is still prone but supine positioning has significantly increased (16.2%vs6%, p=0.0001). Percutaneous access by radiology showed a small significant upward trend (66.2% vs. 62%, p<0.006). Balloon dilatation has increased in usage (63.4% vs 48%, p=0.0001) with a reduction in metal/Teflon serial dilator usage. Significantly more Consultants perform PCNL themselves than compared with 2011 (84.4% vs. 79%, p=0.0001). Ultrasound fragmentation devices are more widely used (48.8% vs 42.2%, p=0.0002). Lift out PCNL is seen significantly less (-5.6%, p=0.0001). Nephrostomy drainage usage post operatively was similar. Intraoperatively 78.6% of patients were believed to be stone free, confirmed in 68.6% with postop imaging, similar to data in 2011. Complication rates are similar and presented in Table 1. Comparison with English HES data suggests increasing reporting of PCNL cases to the BAUS data registry following compulsory participation in 2014 (Table 2.) CONCLUSIONS The BAUS PCNL registry is a unique resource for UK surgeons, providing vital data on current practice, and trends representing evolving PCNL practices. Compulsory participation from 2014 highlights increasing participation in the registry. The registry allows audit of individual practice against national outcome data and helps surgeons to counsel patients for this complex index endourological procedure. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e440 Advertisement Copyright & Permissions© 2016MetricsAuthor Information William Finch More articles by this author Robert Calvert More articles by this author Sarah Fowler More articles by this author James Armitage More articles by this author Jonathan Glass More articles by this author John Withington More articles by this author Oliver Wiseman More articles by this author Stuart Irving More articles by this author Neil Burgess More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Medical Therapy1 Apr 2015MP41-13 VITAMIN D REPLACEMENT IN RECURRENT RENAL STONE FORMERS WITH HYPERCALCIURIA DOES NOT INCREASE URINE CALCIUM EXCRETION OR RENAL STONE GROWTH Luke McGuinness, Robert Calvert, and Vinita Mishra Luke McGuinnessLuke McGuinness More articles by this author , Robert CalvertRobert Calvert More articles by this author , and Vinita MishraVinita Mishra More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1641AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Reduced vitamin D levels are found in up to 50% of recurrent renal stone patients. Reluctance to replace vitamin D in these patients exists due to a theoretical risk of increased intestinal calcium absorption and subsequent renal excretion. Recent evidence suggests that increased absorption might be offset by increased bone deposition with no effect on urine excretion. We aim to assess the effect of pharmacological correction of low vitamin D in hypercalciuric renal stone formers compared to those with adequate vitamin D in a metabolic stone clinic. METHODS Retrospective review of 30 recurrent renal stone formers with hypercalciuria was undertaken. Serum 25 hydroxyvitamin D (25OHD) and 24hr urine biochemistry were measured in all patients at baseline and during follow-up. Renal stone growth was assessed with abdominal x-rays. Hypercalciuria was treated with diet and diuresis advice and pharmacotherapy (thiazide/ potassium citrate/allopurinol). Those with low 25OHD levels (¡Ü50nmol/L) were prescribed vitamin D replacement (VDR). Outcomes of 24hr urine biochemistry and new stone growth were compared between those on VDR (n= 17) and those with adequate 25OHD levels (n= 13). RESULTS Nine patients (30%) had vitamin D deficiency (¡Ü30nmol/L), 8 (27%) had insufficiency (>30 and ¡Ü50nmol/L) and 13 (43%) had adequate levels (>50nmol/L). 17 patients were prescribed vitamin D replacement (mean duration 14 months). 13 patients with adequate levels had mean follow-up of 22 months. No significant difference in baseline 24hr urine biochemistry was seen. Patients on VDR had an increase in 25OHD (33.6 to 74.7nmol/L, p<0.001) whilst 24hr urine calcium levels reduced non-significantly (9.33 to 8.78mmol/24hr, p>0.1). Patients with adequate 25OHD level (64.7nmol/L) had a significant decrease in urinary calcium (10.6 to 8.28mmol/24hr, p=0.003). No other significant changes were seen on urine biochemistry. The mean decrease in urine calcium in those on VDR (0.43mmol/24hr) compared to those with adequate 25OHD (2.28mmol/24hr) was not significant (p=0.15). 10 patients had new stone growth; 6 patients (35%) on VDR and 4 patients (31%) with adequate 25OHD (p>0.5). CONCLUSIONS Low vitamin D levels are present in more than half of hypercalciuric stone formers. Vitamin D replacement does not adversely affect urine calcium levels in patients with low vitamin D status or increase renal stone risk compared to those with adequate levels. Furthermore a beneficial effect may exist due to increased bone mineralisation but further evaluation is required. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e505 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luke McGuinness More articles by this author Robert Calvert More articles by this author Vinita Mishra More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Torsion amongst the elderly population is rarely described. This case presents the oldest surgically confirmed case of testicular torsion, in a 67-year-old male, within the UK. Presenting to the emergency department with a 10-day history of left-sided testicular pain, initially treated with antibiotics. There was no pyrexia or urinary symptoms and negative urine dipstick. In adults above the age of 40, likely diagnoses include epididymo-orchitis, epididymitis, neoplasm or hydrocele. Clinical differentiation with epididymo-orchitis can be difficult in any age range. Clinical signs such as fever, elevated C-reactive protein and positive urine dipstick test are suggestive of epididymo-orchitis/orchitis. This case study demonstrates that testicular torsion can occur at any age, and clinical suspicion should always be high in patients presenting with testicular pain and a negative urine dipstick, regardless of age. Although risk in this subgroup is low, the identification of a potentially reversible testicular abnormality should be of high priority.

BJU InternationalVolume 110, Issue 8 p. E330-E330 MANAGEMENT OF SEVERE BLUNT RENAL TRAUMA IN ADULT PATIENTS: A 10-YEAR RETROSPECTIVE REVIEW FROM AN EMERGENCY HOSPITAL Kee Y. Wong, Kee Y. Wong The Gow Gibbon Urology Department andSearch for more papers by this authorJohn A. Brennan, John A. Brennan Department of Vascular Surgery, Royal Liverpool and Broadgreen University Hospital, Liverpool, UKSearch for more papers by this authorRobert C. Calvert, Robert C. Calvert The Gow Gibbon Urology Department andSearch for more papers by this author Kee Y. Wong, Kee Y. Wong The Gow Gibbon Urology Department andSearch for more papers by this authorJohn A. Brennan, John A. Brennan Department of Vascular Surgery, Royal Liverpool and Broadgreen University Hospital, Liverpool, UKSearch for more papers by this authorRobert C. Calvert, Robert C. Calvert The Gow Gibbon Urology Department andSearch for more papers by this author First published: 28 September 2012 https://doi.org/10.1111/j.1464-410X.2012.11571.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES 1 Aragona F, Pepe P, Patanè D, Malfa P, D'Arrigo L, Pennisi M. Management of severe blunt renal trauma in adult patients: a 10-year retrospective review from an emergency hospital. BJU Int 2012; 110: 744– 8 2 Santucci RA, Fisher MB. The literature increasingly supports expectant (conservative) management of renal trauma – a systematic review. J Trauma 2005; 59: 493– 503. 3 Cross-referencing codes for nephrectomy (OPCS M02) and renal trauma (ICD10 S370) on Hospital Episode Statistics 4 Gill JD, Stewart LF, George NJR, Eardley I. Operative experience of urological trainees in the UK. BJU Int 2012; 109: 1296– 301. 5 Djakovic N, Lynch Th, Martínez-Piñeiro L et al. EAU Guidelines on Urological Trauma, 2009. Available at: http://www.uroweb.org/guidelines/online-guidelines/. Accessed August 2012 Volume110, Issue8October 2012Pages E330-E330 ReferencesRelatedInformation

What's known on the subject? and What does the study add? One of the suggested factors for stent‐related symptoms is that excess distal intravesical stent mass may cause bladder irritation. There is a lack of studies investigating this in a randomised controlled fashion using a validated questionnaire. This study compared two of the most commonly used length of stents (a 30 cm multi‐length vs a 24 cm long stent) and showed no significance difference in stent‐related symptoms in patients with either of these stents. Objective To investigate whether excessive redundant intravesical stent component contributes to the severity of stent‐related symptoms in patients with a ureteric stent. We compared stent‐related symptoms in patients who had either a standard 24 cm or multi‐length ureteric stent. Patients and Methods I n all, 162 patients with upper urinary tract calculi requiring ureteric stent insertion were randomised to receive either a 6 F × 24 cm Contour TM or multi‐length 6 F × 22–30 cm C ontour VL TM stent. Patients were requested to complete the validated B ristol U reteric S tent S ymptom Q uestionnaire ( USSQ ) at 1 and 4 weeks after stent insertion and 4 weeks after removal. The mean scores for each domain of the USSQ for both groups were compared using the Student's t ‐test. Any adverse events, e.g. stent migration, early removal of stent due to stent‐related symptoms and failure of stent insertion, were also recorded. Results In all, 153 patients who had successful stent insertion were requested to complete the USSQ and 74% of patients returned at least the week 1 questionnaire. At 1 and 4 weeks with the stent in situ , comparison of the mean scores showed no significant difference in urinary symptoms, pain, general health, work performance, sexual dysfunction and number of days patients stayed in bed or reduced their routine activities. Three (2%) patients had their stent removed early due to stent‐related symptoms and five (3%) had failed stent insertion. Conclusions This study did not find any difference in symptoms between the 24 cm or multi‐length C ontour stents. However, the study was not powered to detect small differences particularly for the pain symptom domain. Stents should only be used sparingly and the stent dwell‐time should be minimised.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2011633 A MULTI-CENTRE RANDOMIZED CONTROLLED STUDY TO COMPARE THE IMPACT OF DIFFERENT URETERAL STENT LENGTHS ON PATIENTS' QUALITY OF LIFE USING A VALIDATED QUESTIONNAIRE Robert Calvert, Kee Wong, Sudhanshu Chitale, Stuart Irving, Muthuswamy Nagarajan, Chandra Biyani, Anthony Browning, James Young, Anthony Timoney, Francis Keeley, and Neil Burgess Robert CalvertRobert Calvert Liverpool, United Kingdom More articles by this author , Kee WongKee Wong Liverpool, United Kingdom More articles by this author , Sudhanshu ChitaleSudhanshu Chitale Norwich, United Kingdom More articles by this author , Stuart IrvingStuart Irving Norwich, United Kingdom More articles by this author , Muthuswamy NagarajanMuthuswamy Nagarajan Wakefield, United Kingdom More articles by this author , Chandra BiyaniChandra Biyani Wakefield, United Kingdom More articles by this author , Anthony BrowningAnthony Browning Wakefield, United Kingdom More articles by this author , James YoungJames Young Bristol, United Kingdom More articles by this author , Anthony TimoneyAnthony Timoney Bristol, United Kingdom More articles by this author , Francis KeeleyFrancis Keeley Bristol, United Kingdom More articles by this author , and Neil BurgessNeil Burgess Norwich, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1509AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Insertion of ureteral stent is a common urological procedure in both elective and emergency settings. However, indwelling ureteral stent is often associated with significant pain and urinary symptoms. One suggested factor for this is bladder irritation secondary to a long redundant distal end of ureteral stent. The objective of this study is to compare the impact of multi-length 30cm and single length 24cm ureteral stents on patients' quality of life. METHODS 162 patients with upper urinary tract calculi requiring ureteral stent insertion were randomized into group 1 (6Fr x 24cm, Contour™) or group 2 (6Fr x 22–30cm, Contour VL™). Both stents were different in length but were otherwise identical and manufactured by the same company. Patients were requested to complete the validated Bristol ureteric stent symptom questionnaire (USSQ) at 1 and 4 weeks after stent insertion and 4 weeks after removal. Mean scores for each domain of the USSQ in both groups were compared using 2-tailed unpaired t test. Any adverse events such as stent migration, early removal of stent due to stent-related symptoms and failure of stent insertion were also recorded. RESULTS 153 patients who had successful ureteral stent insertion were requested to complete the USSQ. The response rate was 74% (62 and 51 patients in group 1 and 2 respectively). There were no significant difference in both groups in terms of age (p=0.47) or sex (p=0.22). At 1 and 4 weeks with the stent in situ, comparison of the mean domain scores demonstrated no significant difference in urinary symptoms (p=0.42 and p=0.19), pain (p=0.84 and p=0.39) and general health (p=0.48 and p=0.98). This is also similar for work performance (p=0.87 and p=0.78), sexual dysfunction (p=0.71 and p=0.41) and number of days patients stayed in bed (p=0.11 and 0.65) or reduced their routine activities (p=0.10and p=0.63). There were 3 (2%) patients who had stent removed earlier due to severe stent-related symptoms (all from group 1) and 5 (3%) patients with failed stent insertion. There was no ureteral stent migration noted in this study. CONCLUSIONS Based on this study, there is no difference in the impact on quality of life in patients who had either a multi-length or 24cm ContourTM ureteral stent. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e256 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Calvert Liverpool, United Kingdom More articles by this author Kee Wong Liverpool, United Kingdom More articles by this author Sudhanshu Chitale Norwich, United Kingdom More articles by this author Stuart Irving Norwich, United Kingdom More articles by this author Muthuswamy Nagarajan Wakefield, United Kingdom More articles by this author Chandra Biyani Wakefield, United Kingdom More articles by this author Anthony Browning Wakefield, United Kingdom More articles by this author James Young Bristol, United Kingdom More articles by this author Anthony Timoney Bristol, United Kingdom More articles by this author Francis Keeley Bristol, United Kingdom More articles by this author Neil Burgess Norwich, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Objective: To study using immunohistochemistry the localization of P2X receptor subtypes on the head of immature sperm in the human, mouse, hamster, and rat caputDesign: Basic research.Setting: University-based hospital.Patient(s): Three human epididymides were obtained from patients undergoing orchidectomy for metastatic prostate cancer.Main Outcome Measure(s): P2X(1), P2X(2), P2X(3), and P2X(4) receptor immunolocalization on sperm.Result(s): In the present study, P2X(1,2), (and 3) receptor localization was immunohistochemically demonstrated on the head of immature sperm in the human, mouse, hamster, and rat caput epididymidis. P2X(4) receptor immunostaining was also observed on the head of sperm in the caput epididymidis of mice, hamsters, and humans, but not. rats. There was a subsequent loss of receptor staining on sperm in the cauda epididymidis, except in humans where staining of P2X(4) receptors persisted. Comparision with peanut agglutinin (PNA) binding studies suggested the P2X receptors were located on the acrosome membrane. P2X(5-7) receptors were examined but found to be absent.Conclusion(s): The change in localization of receptor subtypes is coincidental with the functionally essential morphologic and maturational changes seen in sperm as they travel through the epididymis, and is suggestive of a role for purinergic signaling in sperm maturation and possibly fertility. (Fertil Steril (R) 2010;93:1415-20. (C)2010 by American Society for Reproductive Medicine.)

It is not clear how the increase in intraluminal pressure behind an obstructing ureteric calculus causes an increase in action potential frequency in ureteric sensory nerves so the pain messages are transmitted to the brain. It has been proposed that ureteric distension causes urothelial release of ATP, which activates purinoceptors on suburothelial nociceptive sensory nerves. The purpose of this study was to determine whether distension of the human ureter results in the release of ATP and whether the nociceptive P2 receptor, P2X(3), is expressed on suburothelial sensory nerves in the human ureter. Human ureter segments were perfused with Krebs solution and intermittently distended to a range of pressures. Samples of perfusate were collected throughout and the ATP concentration ([ATP]) was determined using a luciferin-luciferase assay. Sections of ureter were stained using antibodies against P2X(3) and capsaicin receptors (TRPV1). [ATP] rose to more than 10 times baseline levels after distension beyond a threshold of 25-30 cmH(2)O. Immunofluorescence studies on consecutive frozen sections showed that suburothelial nerves stained positively for P2X(3) and capsaicin receptors, with no staining in controls. These findings are consistent with the hypothesis that purinergic signalling is involved in human ureteric mechanosensory transduction, leading to nociception.

OBJECTIVETo examine rabbit cavernosal smooth muscle (CSM) relaxation to ATP, ADP and UTP in normal rabbits and in models of conditions that predispose to erectile dysfunction (ED), diabetes mellitus (DM; induced for 6 months) and bladder outlet obstruction (BOO, 6 weeks after surgery).MATERIALS AND METHODSConcentration‐response curves (CRCs) were constructed to ATP, ADP and UTP on CSM from control rabbits in the absence and presence of antagonists. In addition, CRCs were constructed to ATP in CSM from rabbits with DM and BOO.RESULTSATP and UTP caused equipotent, dose‐dependent relaxations of pre‐contracted normal rabbit CSM; ADP was more potent. Relaxation was inhibited by Reactive Blue 2, but not by suramin, 8‐p‐sulfophenyltheophylline or L‐NG‐nitroarginine methyl ester. In rabbits with DM and those with partial BOO, ATP‐mediated CSM relaxation was less than in control rabbits. Pharmacological profiling suggests that purine‐induced CSM relaxation might be mediated by P2Y1 and P2Y4 receptors in the rabbit.CONCLUSIONSIn healthy rabbits, ATP released from nerves appears to produce relaxation of CSM via P2Y4 receptors on smooth muscle, while ADP, acting on P2Y1 receptors on endothelial cells, produces relaxation via nitric oxide. Alterations in CSM purinergic signalling might be implicated in the pathophysiology of ED associated with DM and BOO. Characterization of purinergic signalling in CSM might highlight new therapeutic targets for treating ED.