Improving Access and Quality of Care for Kidney Stone Patients in an Underserved Community.

There is a call to improve Medicaid patient access to health care, enhance quality and outcomes of care, and reduce overall financial burden. We sought to build a comprehensive kidney stone program to help patients navigate through the acute and preventive aspects of stone disease by increasing multidisciplinary referrals and compliance with recommendations and decreasing no-show rates at first follow-up and repeat stone encounters after initial evaluation. A collaborative multidisciplinary program was established at our single institution consisting of urology, nephrology, and dietary specialists to be piloted over a 3-year period.

A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics for Percutaneous Nephrolithotomy in Moderate to High Infectious Risk Population: A Report from the EDGE Consortium.

Purpose: Postoperative infectious related complications are not uncommon after percutaneous nephrolithotomy. Previously, we noted that 7 days of antibiotics did not decrease sepsis rates compared to just perioperative antibiotics in a low risk percutaneous nephrolithotomy population. This study aimed to compare the same regimens in individuals at moderate to high risk for sepsis undergoing percutaneous nephrolithotomy.

Trends in Acute Pain Management for Renal Colic in the Emergency Department at a Tertiary Care Academic Medical Center.

Renal colic secondary to kidney stone disease is a common reason for emergency department (ED) visits and often leads to patients receiving narcotic medications. The objective of this study was to describe longitudinal analgesia prescribing patterns for kidney stone patients acutely managed in the ED. This was a retrospective chart review of patients who presented to the ED between 2013 and 2018 and were subsequently diagnosed with a kidney stone.

Single-Use Grasper Integrated Flexible Cystoscope for Stent Removal: A Micro-Costing Analysis-Based Comparison.

A single-use flexible cystoscope with integrated grasper (; Coloplast, Denmark) has recently become commercially available. The objective of our study is to compare the costs of stent removal in an outpatient clinical environment between the single-use system (Coloplast) to our existing approach using a reusable cystoscope and stent grasper. The number of stent removal procedures at our tertiary center was recorded as a proportion of all cystoscopic procedures performed between February 2016 and February 2017.

The Impact of Ureteral Access Sheath Use on the Development of Abnormal Postoperative Upper Tract Imaging after Ureteroscopy.

Purpose: Ureteral access sheaths are commonly used during ureteroscopy to facilitate stone removal, improve visibility and maintain low intrarenal pressures. However, the use of a ureteral access sheath can cause ureteral wall ischemia and ureteral tears, potentially increasing the risk of postoperative ureteral stricture and obstruction. We studied the impact of ureteral access sheath use on postoperative imaging studies.

Reducing Fluoroscopy Time in Percutaneous Nephrolithotomy.

Reducing fluoroscopy time (FT) during percutaneous nephrolithotomy (PCNL) is an opportunity for stewardship of ionizing radiation in stone patients. We present our initial results of a radiation reduction protocol (RRP) used during PCNL with fluoroscopy-guided access by the urologist. Retrospective chart review of all PCNL cases performed between January and October 2017, divided in two groups: pre-RRP (group 1) and post-RRP (group 2).

Medical dissolution therapy for the treatment of uric acid nephrolithiasis.

Introduction: Uric acid (UA) nephrolithiasis represents 10% of kidney stones in the US with low urine pH and high saturation of UA as the main risk factors for stone development. Dissolution therapy for UA kidney stones via urinary alkalization has been described as a treatment option. We present our experience in treating UA nephrolithiasis with medical dissolution therapy.

Holmium-YAG laser: impact of pulse energy and frequency on local fluid temperature in an in-vitro obstructed kidney calyx model.

During laser lithotripsy, energy is transmitted to both the stone and the surrounding fluid. As the energy is delivered, the temperature will rise. Temperatures ≥60  °  C can cause protein denaturation.

Supracostal access tubeless percutaneous nephrolithotomy: minimizing complications.

Introduction And Objective: Supracostal access in percutaneous nephrolithotomy (PCNL) may be avoided due to concern for thoracic complications. The objective of the study is to report the safety and efficacy of supracostal access utilizing a tubeless (stent only) PCNL technique.

Patients And Methods: Retrospective review of perioperative outcomes of 70 patients (76 renal units) who underwent a supracostal tubeless PCNL.

Mitomycin-C and urethral dilatation: A safe, effective, and minimally invasive procedure for recurrent vesicourethral anastomotic stenoses.

Purpose: To report the safety and efficacy of mitomycin-C (MMC) injection followed by urethral dilatation for the treatment of recurrent vesicourethral anastomotic stenosis (VUAS) post-radical prostatectomy, and to report the outcome for patients treated for concomitant postprostatectomy incontinence.

Materials And Methods: A total of 29 patients with postprostatectomy incontinence and diagnosed with recurrent VUAS were recruited between March 2009 and January 2014 in this longitudinal case series. Under sedation, MMC was injected at the 3, 6, and 9 o'clock position, followed by urethral dilatation to 26F.

Retrograde leak point pressure measurement improves outcomes of the Virtue male sling for postprostatectomy incontinence.

Introduction: We aimed to compare the efficacy of two different sling tensioning approaches, and to report our experience, including safety and impact on quality of life (QoL) of the Virtue male sling for the treatment of postprostatectomy incontinence (PPI).

Methods: From our prospectively maintained database, we retrospectively identified all men treated with the Virtue male sling for PPI between March 2009 and February 2014 by two urologists in two institutions. Baseline demographic data and the sling tensioning method were abstracted from the database.

Genitourinary tuberculosis in North America: A rare clinical entity.

Introduction: Although tuberculosis (TB) is the most common cause of mortality from infectious diseases worldwide, genitourinary TB in North America is rare. We review 3 cases of genitourinary TB diagnosed within the last 5 years.

Cases: The first case is that of a 76-year-old African-Canadian woman who was referred for percutaneous nephrolithotomy of right lower pole renal stones.

Adrenal lymphangioma: a rare cystic lesion of the adrenal.

We herein report the case of a left adrenal lymphangioma in a 52-year-old asymptomatic female and review the pertinent literature relatable to this rare, benign lesion.

Effects of dextromethorphan on in vitro contractile responses of mouse and rat urinary bladders.

Purpose: Dextromethorphan (DXM) is a cough-suppressing ingredient in a variety of over-the-counter cough and cold medications. Dextromethorphan elevates the threshold for coughing primarily through a central mechanism. At doses recommended for treating coughs the drug is safe and effective.

Comparative effects of in vitro ischemia on contractile responses of mouse and rat bladders to various forms of stimulation.

Objectives: To compare in an in vitro study the sensitivity of rat and mouse bladders to ischemia and reperfusion. Urinary bladder dysfunction is related to ischemia and reperfusion. Several studies have been conducted in which one animal model was used in the urinary bladder dysfunction experiments, but very few studies have compared the consequences of urinary bladder dysfunction in different species.