Transurethral unroofing of a Cowper's syringocele.

Syringoceles are cystic dilations of the bulbourethral gland, also known as Cowper's gland. Syringoceles are a rare pathology with no standard treatment. Herein, we report the diagnosis and endoscopic management of an imperforate syringocele causing bothersome urinary symptoms in an adult male patient.

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.

Percutaneous Nephrolithotomy Access: A Meta-Analysis Comparing Access by Urologist Radiologist.

Percutaneous nephrolithotomy is a minimally invasive procedure indicated for the management of staghorn calculi or renal calculi >2.0 cm. Percutaneous renal access is a critical step in this procedure and can be performed by either urologists or interventional radiologists.

Comparison of Management and Outcomes of Symptomatic Urolithiasis During the COVID-19 Pandemic to a Comparative Cohort.

Objective: To analyze the clinical presentation and outcomes for patients who presented with symptomatic urolithiasis during the initial months of the COVID-19 pandemic.

Methods: We retrospectively reviewed Emergency Department (ED) presentations from a Philadelphia healthcare system for symptomatic urolithiasis between March and June 2020 and compared these with presentations for the same time period from the year prior. Patient demographics, stone characteristics, management, and clinical outcomes were compared between the 2 years.

Improving Compliance with 24-H Urine Collections: Understanding Inadequacies in the Collection Process and Risk Factors for Poor Compliance.

Purpose Of Review: The purpose of this review paper is to describe the 24-h urine collection in terms of its utility, collection process, and common problems with its acquisition.

Recent Findings: Although 24-h urine collections are standard of care for high-risk stone formers, several nuances in test acquisition including inaccurate urine collections 50% of the time and poor patient compliance limit its potential utility. Compliance in obtaining 24-h urine collections has been shown to be improved in patients who have not undergone surgical treatment of urinary calculi, patients with metabolic stone disease or family history of stone disease, Caucasian ethnicity, and in those with more sedentary occupations.

Investigating Fluid Intake in an Underserved Community: What Factors Are Associated with Low Urine Volume on 24-Hour Urine Collection?

Stone prevention is dependent on high fluid intake, with evidence that low urine volume (LUV) can promote nephrolithiasis in the absence of other metabolic abnormalities. Herein, we investigate patient-related factors associated with LUV on initial 24-hour urine collection in an underserved population. A retrospective chart review was performed of patients treated by a single surgeon for nephrolithiasis from August 2014 to January 2019.

Prescribing Trends in Post-operative Pain Management After Urologic Surgery: A Quality Care Investigation for Healthcare Providers.

Objective: To assess prescribing and refilling trends of narcotics in postoperative urology patients at our institution. Although the opioid epidemic remains a public health threat, no series has assessed prescribing patterns across urologic surgery disciplines following discharge.

Methods: All urologic surgeries were retrospectively reviewed from May 2017-April 2018.

Dual-Energy CT for Urinary Stone Evaluation.

Purpose Of Review: Conventional CT imaging is an excellent tool for the diagnosis of nephrolithiasis however is limited in its ability to detect stone composition. Dual-energy CT (DECT) scans have demonstrated promise in overcoming this limitation. We review the current utility of DECT in nephrolithiasis.

Nonalcoholic Fatty Liver Disease Is an Independent Risk Factor for Nephrolithiasis in Women: Findings from NHANES III.

To determine if radiologically diagnosed nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for nephrolithiasis using data from National Health and Nutrition Examination Survey III (NHANES III). NHANES III participants aged 20-74 years who underwent hepatobiliary ultrasound were classified as with NAFLD (moderate or severe hepatic steatosis in absence of other known causes of liver disease;  = 2498) or without NAFLD (controls;  = 9361). Risk of nephrolithiasis caused by NAFLD was estimated using logistic regression with propensity score adjustment.

Multidisciplinary management of adult cloacal exstrophy complications: A challenging case of nephrolithiasis and abdominal wall extrusion of a catheterizable ileal pouch.

Cloacal exstrophy is a rare congenital syndrome which comprises multiple genitourinary, gastrointestinal and musculoskeletal anomalies. The long-term effects following childhood cloacal exstrophy management is poorly characterized in living adults. In this report, a 42-year-old female born with cloacal exstrophy presented after numerous prior surgical reconstructions with abdominal extrusion of a catheterizable ileal pouch and bilateral staghorn calculi.

Factors Associated With Compliance With 24-Hour Urine Collection.

Objective: To identify how demographic factors, stone-associated medical comorbidities, and treatment predict compliance with 24-hour urine collection.

Materials And Methods: A retrospective medical record review of patients treated for urolithiasis between August 2014 and March 2017 was performed. Patient demographics, medical characteristics, stone factors, type of treatment, and compliance data were included for patients requested to submit a collection.

Use of Google Trends to Track Online Behavior and Interest in Kidney Stone Surgery.

Objective: To explore internet search trends data as a unique resource for monitoring online health information-seeking behavior. We utilized Google trends to sample population interest and search inquiries into surgical treatment options of kidney stones, and we examined the relative frequency of searches across the United States.

Methods: Google trends was queried via the Google Insights for Search (http://google.

Endoscopic Management of Ureteral Strictures: an Update.

Purpose Of Review: This review focuses on the role of endoscopic treatment of ureteral stricture disease (USD) in the era of minimally invasive surgery.

Recent Findings: There is a relative paucity of recent literature regarding the endoscopic treatment of USD. Laser endopyelotomy and balloon dilation are associated with good outcomes in treatment-naïve patients with short (< 2 cm), non-ischemic, benign ureteral strictures with a functional renal unit.

Do Urinary Cystine Parameters Predict Clinical Stone Activity?

Purpose: An accurate urinary predictor of stone recurrence would be clinically advantageous for patients with cystinuria. A proprietary assay (Litholink, Chicago, Illinois) measures cystine capacity as a potentially more reliable estimate of stone forming propensity. The recommended capacity level to prevent stone formation, which is greater than 150 mg/l, has not been directly correlated with clinical stone activity.

Extracorporeal Shock Wave Therapy: Current Perspectives and Future Directions.

Purpose Of Review: Since its introduction, extracorporeal shock wave lithotripsy (ESWL) has undergone a variety of changes; however, it remains one of the most utilized treatment modalities for urolithiasis. The goal of this review is to provide the practicing urologist an update on contemporary trends, new technologies, and related controversies in utilizing ESWL for stone treatment.

Recent Findings: ESWL use has come under scrutiny with a shift in focus to cost-effectiveness and healthcare outcomes.

Factors Associated with Compliance in Submitting 24-Hour Urine Collections in an Underserved Community.

Purpose: Patients living in underserved areas do regularly express an interest in stone prevention; however, factors limiting participation, aside from obvious cost considerations, are largely unknown. To better understand factors associated with compliance with submitting 24-hour urine collections, we reviewed our patient experience at the kidney stone clinic at a hospital that provides care for an underserved urban community.

Materials And Methods: A retrospective chart review of patients treated for kidney and/or ureteral stones between August 2014 and May 2016 was performed.

Sarcomatoid Squamous Cell Carcinoma of the Renal Pelvis Masquerading as Emphysematous Pyelonephritis with Staghorn Calculus.

Background: Staghorn calculi are well-established risk factors for recurrent urinary tract infections (UTIs) and subsequent renal deterioration. Less commonly, long-term urothelial irritation from a calculus may also pose a risk of malignant transformation.

Case Presentation: A 77-year-old male with multiple medical comorbidities presented with a chronic right renal pelvic staghorn calculus and findings concerning for emphysematous pyelonephritis.

Comparative Effects of Irreversible Electroporation, Radiofrequency Ablation, and Partial Nephrectomy on Renal Function Preservation in a Porcine Solitary Kidney Model.

Objective: To evaluate kidney function preservation or regeneration and pathological changes post-irreversible electroporation (IRE) in comparison with partial nephrectomy and radiofrequency ablation (RFA) in a solitary kidney porcine model. Tissue ablation using IRE has been reported to spare critical anatomic structures within or near the ablation zone with associated regeneration of adjacent parenchyma, possibly offering functional preservation.

Methods: Fifteen pigs initially underwent laparoscopic nephrectomy.

Association of estimated glomerular filtration rate with 24-h urinalysis and stone composition.

The aim of this study is to determine the association of estimated glomerular filtration rate (eGFR) with 24-h urine analysis and stone composition. We performed a retrospective review of 1060 stone formers with 24-h urinalysis, of which 499 had stone composition analysis available. Comparisons of baseline patient characteristics and urinary abnormalities across eGFR groups (<60, 60-89.

An Assessment of Patient Comfort and Morbidity After Robot-Assisted Radical Prostatectomy with Suprapubic Tube Versus Urethral Catheter Drainage.

Objective: Robot-assisted laparoscopic prostatectomy (RALP) with suprapubic tube (SPT), compared to urethral catheter (UC) drainage, has been proposed to improve patient comfort and recovery. We sought to compare short-term outcomes for pain and morbidity after RALP with SPT vs UC drainage.

Methods: Between August 2012 and 2014, 159 men underwent a RALP and prospectively completed a questionnaire addressing postoperative pain and satisfaction.

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.

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.

Equivocal ureteropelvic junction obstruction on diuretic renogram--should minimally invasive pyeloplasty be offered to symptomatic patients?

Purpose: Equivocal ureteropelvic junction obstruction refers to clinical symptoms and/or other radiological suggestions of possible ureteropelvic junction obstruction but with inconclusive results of obstruction on diuretic renogram. We evaluated long-term outcomes in patients with equivocal ureteropelvic junction obstruction treated with minimally invasive pyeloplasty.

Materials And Methods: We retrospectively analyzed the records of 125 consecutive patients who underwent minimally invasive pyeloplasty as performed by a single surgeon from May 2004 to July 2013.

A novel device to prevent stone fragment migration during percutaneous lithotripsy.

Purpose: We developed a novel device to capture stones in vivo in an enclosed bag (PercSac) to prevent dispersion of stone fragments during percutaneous nephrolithotomy (PCNL) or cystolitholapaxy. We report on our initial feasibility trials of the PercSac device.

Materials And Methods: PercSac consists of a specially designed polyethylene bag that is fitted over the shaft of a rigid nephroscope.