Upper pole urologist-obtained percutaneous renal access for PCNL is safe and efficacious.

INTRODUCTION: Interventional radiologist may be hesitant to obtain upper pole access for percutaneous nephrolithotomy (PCNL) due to a higher complication rate. Renal access gained by urologists may achieve higher stone-free rates with similar complication rates. We evaluate our institution's contemporary results of percutaneous renal access in the upper pole for nephrolithotomy by urologists, which we believe both safe and efficacious. MATERIALS AND METHODS: This retrospective chart review included all PCNL's performed by fellowship-trained endourologists from 2003 to 2014 at a single institution. Inclusion criteria included patients in which renal access was obtained by the urologist via the upper pole for PCNL. Stone-free status was determined by either KUB or CT scan on POD #1. Patients without stones visible on KUB or less than 4 mm on CT were considered stone-free. RESULTS: A total of 144 patients obtained upper pole access for PCNL. There were a total of 53 (37%%) staghorn calculi, of which 35 (66%) were partial staghorn stones. Renal access was obtained above 11th rib in 12.5% (n = 18), between the 11th and 12th rib in 57.6% (n = 83), subcostal in 14.6% (n = 21) and undetermined in the rest. Complications were seen in 18 (12.5%) of patients. Hydropneumothorax requiring chest tube was seen in 8 (5.6%) patients. Postoperative imaging confirmed 93 (64.5%) patients stone-free, and 35 (24.3%) required a second look PCNL. CONCLUSIONS: Our experience with upper pole percutaneous renal access for nephrolithotomy has shown that it has an acceptable complication risk. It should be a part of an endourologist's armamentarium that operate on large burden, complex stones or ureteral pathology.

Effect of Sacral Neuromodulation on Outcome Measures and Urine Chemokines in Interstitial Cystitis/Painful Bladder Syndrome Patients.

OBJECTIVES: Sacral neuromodulation (SNM) may improve interstitial cystitis/painful bladder syndrome (IC/BPS) symptoms of urinary frequency, urgency and perhaps even pain, but objective measures of improvement are lacking. We evaluated the potential for urinary chemokines to serve as measures of treatment response over time to SNM. METHODS: Women with IC/BPS undergoing SNM consented for this study. Three-day bladder/pain diaries were collected at baseline and validated Interstitial Cystitis Symptom Problem Index (ICSPI) scores and mid-stream urine specimens were collected at baseline and at 24 weeks after successful implant. Collected urine was screened for infection by dipstick and analyzed for chemokines by luminex xMAP analysis. RESULTS: At baseline (n = 16), urine levels of CXCL-1 positively correlated with pain score (r = 0.63, P = 0.009), urgency (r = 0.61, P = 0.01), ICSPI (r = 0.43, P = 0.09) and daily voids (r = 0.44, P = 0.08). ICSPI and pain scores also positively correlated with sIL-1ra (r = 0.50, P = 0.04) and monocyte chemotactic protein-1 (MCP-1) or CCL2 positively correlated with daily voids (r = 0.45, P = 0.07) only. At 24 weeks, the median ICSPI index fell from 28 to 15 (n = 7, P = 0.008). Urine levels of sIL-1ra (633.8 ± 188.2 vs. 149.9 ± 41.62 pg/mL) and MCP-1 (448.3 ± 11.6 vs. 176.9 ± 46.16 pg/mL) and CCL5 (20.78 ± 4.09 vs. 11.21 ± 4.12 pg/mL) were also significantly reduced at the follow-up relative to baseline values (P = 0.04). Multivariable analysis of data revealed that sIL-1ra and MCP-1 together explained the majority of variance in data. Levels of CXCL-1, CXCL-10, interleukin (IL)-8, vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF) were also reduced at 24 weeks, but differences were not significant. CONCLUSIONS: Concomitant decrease in urine levels of chemokines especially MCP-1 was associated with treatment response of SNM. These results support the role of chemokines as downstream effectors of neuromodulation response and could serve as potential non-invasive measures of treatment response. CLINICAL TRIAL REGISTRATION NUMBER: NCT01739946.

Heat stability and acid gelation properties of calcium-enriched reconstituted skim milk affected by ultrasonication.

The aggregation of proteins after heating of calcium-fortified milks has been an ongoing problem in the dairy industry. This undesirable effect restricts the manufacture of calcium rich dairy products. To overcome this problem, a completely new approach in controlling the heat stability of dairy protein solutions, developed in our lab, has been employed. In this approach, high intensity, low frequency ultrasound is applied for a very short duration after a pre-heating step at ⩾70 °C. The ultrasound breaks apart whey/whey and whey/casein aggregates through the process of acoustic cavitation. Protein aggregates do not reform on subsequent post-heating, thereby making the systems heat stable. In this paper, the acid gelation properties of ultrasonicated calcium-enriched skim milks have also been investigated. It is shown that ultrasonication alone does not change the gelation properties significantly whereas a sequence of preheating (72 °C/1 min) followed by ultrasonication leads to decreased gelation times, decreased gel syneresis and increased skim milk viscosity in comparison to heating alone. Overall, ultrasonication has the potential to provide calcium-fortified dairy products with increased heat stability. However, enhanced gelation properties can only be achieved when ultrasonication is completed in conjunction with heating.

Neuromodulation and the neurogenic bladder.

Neurogenic bladder resulting from spinal cord injury and spina bifida has a profound impact on voiding function. This article reviews the current literature with regards to electrical stimulation for neurogenic bladder and the clinical outcomes associated with sacral neuromodulation, pudendal neuromodulation, posterior tibial nerve stimulation, and the Finetech-Brindley posterior/anterior stimulator. In addition, the world literature reviewing hemilaminectomy and ventral root micro anastomosis is discussed. The article also examines the safety of magnetic resonance imaging in patients with implanted neurostimulators and discusses common complications. Neuromodulation, both electrical and physical, play an important role in the management of neurogenic bladder.

Role of positional instillation of contrast cystography in the algorithm for evaluating children with confirmed pyelonephritis.

OBJECTIVES: To assess the utility of positional instillation of contrast (PIC) cystography in detecting vesicoureteral reflux (VUR) in patients with renal scarring from recurrent febrile urinary tract infections that standard voiding cystourethrography and nuclear cystogram imaging failed to reveal. METHODS: Between June 2004 and November 2004, a total of 5 pediatric patients with recurrent febrile urinary tract infections and radiologic evidence of upper tract involvement were examined with PIC cystography. All patients had at least one previous negative standard reflux study (voiding cystourethrography or nuclear cystography). RESULTS: All 5 patients showed VUR on PIC cystography. Unilateral reflux was detected in 3 patients, and 2 patients had bilateral VUR. CONCLUSIONS: The PIC cystogram should be integrated into the algorithm for diagnosing patients with recurrent febrile urinary tract infection, who do not exhibit VUR on standard imaging modalities. The morbidity associated with undiagnosed VUR, as demonstrated by this group of patients, suggests that permanent renal damage may be prevented by early diagnosis and treatment.