Heterogeneity in stone culture protocols and endourologist practice patterns: a multi-institutional survey.

Kidney stone cultures can be beneficial in identifying bacteria not detected in urine, yet how stone cultures are performed among endourologists, under what conditions, and by what laboratory methods remain largely unknown. Stone cultures are not addressed by current clinical guidelines. A comprehensive REDCap electronic survey sought responses from directed (n = 20) and listserv elicited (n = 108) endourologists specializing in kidney stone disease.

Use of ultra-low dose computed tomography versus abdominal plain film for assessment of stone-free rates after shock-wave lithotripsy: implications on emergency room visits, surgical procedures, and cost-effectiveness.

The aims of this investigation were: (1) to compare residual stone-fragment (RSF) detection rates of ultra-low dose computed tomography (ULD-CT) and abdominal plain film (KUB) in urolithiasis patients undergoing shock-wave lithotripsy (SWL), and (2) to evaluate the downstream sequelae of utilizing these two disparate imaging pathways of differing diagnostic fidelity. A retrospective chart-review of patients undergoing SWL at two high-volume surgical centers was undertaken (2013-2016). RSF diagnostic rates of ULD-CT and KUB were assessed, and the impact of imaging modality used on subsequent emergency room (ER) visits, unplanned procedures, and cost-effectiveness was investigated.

New Persistent Opioid Use After Outpatient Ureteroscopy for Upper Tract Stone Treatment.

Objective: To measure the incidence of persistent opioid use following ureteroscopy (URS). Over 100 Americans die every day from opioid overdose. Recent studies suggest that many opioid addictions surface after surgery.

A Review of Male Sexual Health and Dysfunction Following Surgical Treatment for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms.

Purpose Of Review: Review how the various surgical treatments for benign prostatic hyperplasia and lower urinary tract symptoms impact on male sexual health and function.

Recent Findings: The interplay between benign prostatic hyperplasia and erectile function is complex, and the conditions seem linked. Most cavitating procedures to improve male voiding will degrade ejaculatory and possibly erectile function.

Neuroendocrine Tumor of the Ureter: A Zebra Among Horses.

Primary neuroendocrine tumors of the upper urinary tract are extremely rare. We report a case of small cell carcinoma of the ureter that presented masquerading as a distal ureteral stone. A 55-year-old lady presented to our clinic with 1 month history of right lower back pain and hematuria.

Ureteropelvic Junction Obstruction Secondary to Metastatic Relapse of Breast Cancer.

We describe the case of a 53-year-old woman with a history of localized breast cancer who presented with flank pain and was found to have new-onset obstruction of the left ureteropelvic junction. Although initially believed to be unrelated to her history of prior malignancy, intraoperative assessment of tissue from the ureteropelvic junction during planned laparoscopic pyeloplasty revealed urothelial infiltration by carcinoma of breast origin.

Can Activities of Daily Living Predict Complications following Percutaneous Nephrolithotomy?

Purpose: Activities of daily living provide information about the functional status of an individual and can predict postoperative complications after general and oncological surgery. However, they have rarely been applied to urology. We evaluated whether deficits in activities of daily living could predict complications after percutaneous nephrolithotomy and how this compares with the Charlson comorbidity index and the ASA(®) (American Society of Anesthesiologists(®)) classification.

The Expanded Use of Percutaneous Resection for Upper Tract Urothelial Carcinoma: A 30-Year Comprehensive Experience.

Introduction: The gold standard treatment for upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNU). The role of endoscopic resection is limited to low-risk patients. In this study, we present our 30-year experience in the endoscopic management of UTUC.

Outcomes of Laparoscopic Partial Nephrectomy in Patients Continuing Aspirin Therapy.

Purpose: A clinical dilemma surrounds the use of aspirin therapy during laparoscopic partial nephrectomy. Despite reduced cardiac morbidity with perioperative aspirin use, fear of bleeding related complications often prompts discontinuation of therapy before surgery. We evaluate perioperative outcomes among patients continuing aspirin and those in whom treatment is stopped preoperatively.

Stenting for malignant ureteral obstruction: Tandem, metal or metal-mesh stents.

Extrinsic malignant compression of the ureter is not uncommon, often refractory to decompression with conventional polymeric ureteral stents, and frequently associated with limited survival. Alternative options for decompression include tandem ureteral stents, metallic stents and metal-mesh stents, though the preferred method remains controversial. We reviewed and updated our outcomes with tandem ureteral stents for malignant ureteral obstruction, and carried out a PubMed search using the terms "malignant ureteral obstruction," "tandem ureteral stents," "ipsilateral ureteral stents," "metal ureteral stent," "resonance stent," "silhouette stent" and "metal mesh stent.

Live surgical demonstrations: An endangered species.

Despite the increasing controversy surrounding live surgical demonstrations, they remain an incredibly valuable tool for urologic education. Live surgery is the most effective means to demonstrate certain surgical techniques and intraoperative decision making. The many potential benefits far outweigh the potential concerns when live surgical events are performed in a thoughtful regulatory framework.

Does hypertension impact 24-hour urine parameters in patients with nephrolithiasis?

Objective: To examine the differences in 24-hour urine parameters and stone composition between patients with and without systemic hypertension (HTN) in a large cohort of stone formers.

Materials And Methods: We performed a retrospective review over a 10-year period of patients with stone, who had completed a 24-hour urinalysis (Litholink) and for whom demographic information was available, including the presence of HTN. Univariate and multivariate analyses were performed, comparing the 24-hour urinalysis profiles of patients with HTN with that of normotensive patients.

Percutaneous nephrolithotomy during uninterrupted aspirin therapy in high-cardiovascular risk patients: preliminary report.

Objective: To determine the feasibility and safety of performing percutaneous nephrolithotomy (PCNL) in high-cardiovascular risk patients remaining on aspirin therapy.

Methods: We retrospectively reviewed all PCNLs performed by 3 fellowship-trained endourologists at a single institution between July 2012 and January 2014. All patients remaining on aspirin for imperative indications through the day of surgery were evaluated for surgical outcomes and thromboembolic events.

Continuing aspirin therapy during percutaneous nephrolithotomy: unsafe or under-utilized?

Introduction: Aspirin, as an inhibitor of platelets, is traditionally discontinued prior to percutaneous nephrolithotomy (PCNL) given the concern for increased surgical hemorrhage. However, this practice is based on expert opinion only, and mounting evidence suggests holding aspirin perioperatively can be more harmful than once thought. We sought to compared PCNL outcomes and complications in patients continuing aspirin to those stopping aspirin perioperatively.

Open, laparoscopic, and robotic ureteroneocystotomy for benign and malignant ureteral lesions: a comparison of over 100 minimally invasive cases.

Introduction: Laparoscopic (LAP) and robot-assisted laparoscopic (RAL) approaches have been applied to ureteroneocystostomies (UNC) although such experience has been limited to a small number of patients and limited follow-up. Herein, we detail our experience with over 100 minimally invasive UNC, the largest such series to date.

Methods: All minimally invasive UNC performed at our institution between 1997 and 2013 and all open UNC performed between 2008 and 2013 were identified.

Association of serum biochemical metabolic panel with stone composition.

Introduction: To determine the association of the basic metabolic panel with stone type.

Methods: The present study was a retrospective review of 492 stone formers with both stone composition analysis and basic metabolic panel available. Analysis of a basic metabolic panel across stone types was carried out using Fisher's exact test and analysis of variance.

Performing in the surgical amphitheater of today: perception of urologists conducting live case demonstrations.

Purpose: To evaluate the perception of urologists who have participated in live case demonstrations (LCDs) regarding safety, educational value/benefits, and ethics.

Methods: A 19-question anonymous survey was sent to urologists who performed and/or moderated LCDs at the World Congress of Endourology meetings from 2008 to 2012. E-survey was distributed via e-mail, and automatic reminders were sent 2 weeks after original distribution if no response was obtained.

Nature of crossing vessels in patients with radiographically normal ureteropelvic junctions: prevalence and anatomic characteristics.

Objective: To evaluate the prevalence and characteristics of crossing vessels in asymptomatic patients with a radiographically normal ureteropelvic junction.

Materials And Methods: We retrospectively reviewed the computed tomography angiography images of 601 patients who were evaluated for possible living organ donation at the University of Minnesota from 2005 to 2008. One patient had asymptomatic hydronephrosis and was excluded from the analysis.

A case series of genital vascular anomalies in children and their management: lessons learned.

Objective: To review our experience with genital vascular anomalies and discuss the management considerations for patients with associated genitourinary defects.

Methods: We reviewed the presentation, course, management considerations, surgical treatment, and follow-up of all cases of genital vascular anomalies treated at a single institution from January 2008 to October 2011. The lesions were classified according to the International Society for the Study of Vascular Anomalies.

Robot-assisted laparoscopic ipsilateral ureteroureterostomy for ectopic ureters in children: description of technique.

Purpose: We report our experience and present our technique with the robot-assisted laparoscopic ipsilateral ureteroureterostomy (IUU) in the management of ureteral duplication with ectopia in children.

Patients And Methods: We reviewed our institutional experience for all patients who underwent a robot-assisted laparoscopic IUU at the University of Minnesota Amplatz Children's Hospital between December 2010 and October 2011. An intraoperative, three-port technique was used after a ureteral stent was placed into the ipsilateral lower pole.

Omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid in the management of hypercalciuric stone formers.

Objective: To investigate the use of fish oil in the dietary management of hypercalciuric stone formers. Prostaglandins have been linked to urinary calcium excretion, suggesting a role for omega-3 fatty acids in the treatment of hypercalciuric urolithiasis.

Methods: We retrospectively studied a cohort of patients treated at our stone clinics from July 2007 to February 2009.