Role of microbiome in kidney stone disease.

PURPOSE OF REVIEW: The process of renal stone formation is complex, multifactorial, and variable depending on the type of stone. The microbiome, whether by direct or indirect action, is a factor that both promotes the formation and protects from developing of renal stones. It is a highly variable factor due to the great interindividual and intraindividual variability that it presents. In recent years, with the incorporation of nonculture-based techniques such as the high-throughput sequencing of 16S rRNA bacterian gene, both intestinal and urinary microbiota have been deeply studied in various diseases such as the kidney stone disease. RECENT FINDINGS: This review has examined the new insights on the influence of the intestinal and urinary microbiome in nephrolithiasis disease and its usefulness as a diagnostic and prognostic tool, highlighting its contribution to the pathogenesis, its ability to modulate it and to influence disease development. SUMMARY: The incidence of urolithiasis has been increasing considerably. These patients represent a significant expense for national health systems. With the knowledge of the influence of the urobiome and intestinal microbiota on the urolithiasis, it could be possible to modulate it to interrupt its development.

Outcomes of ureteroscopy miniaturization on tissue damage and tissue hypoxia in a pig model.

Miniaturization of ureteroscopy materials is intended to decrease tissue damage. However, tissue hypoxia and the gross and microscopic effects on tissue have not been adequately assessed. We compared the gross and microscopic effects of micro-ureteroscopy (m-URS) and conventional ureteroscopy (URS) on the urinary tract. We employed 14 pigs of the Large White race. URS was performed in one of the ureters with an 8/9.8 F ureteroscope, while a 4.85 F m-URS sheath was used in the contralateral ureter. Gross assessment of ureteral wall damage and ureteral orifice damage was performed. For microscopic assessment hematoxylin-eosin staining and immunohistochemistry for detection of tissue hypoxia were conducted. Regarding the macroscopic assessment of ureteral damage, substantial and significant differences were recorded using URS (C = 0.8), but not with m-URS. Microscopic assessment after staining with hematoxylin-eosin revealed greater epithelial desquamation in the URS group (p < 0.05). Pimonidazole staining revealed greater hypoxia in the epithelial cells than in the remainder of the ureteral layers. We conclude that m-URS causes less damage to the ureteral orifice than URS. Histopathological findings show m-URS reduces ureteral epithelial damage compared with conventional ureteroscopy. Both URS and m-URS cause cellular hypoxia.

Adenocarcinoma primario en un remanente ureteral tras una nefrectomía simple / Primary adenocarcinoma of a ureteral remnant stump after nephrectomy

Objetivos: El adenocarcinoma primario de uréter representa un porcentaje mínimo de las neoplasias del tracto urinario superior. El escaso número de casos publicados no permite establecer unas pautas claras en su manejo clínico, diagnóstico y terapéutico. Nuestro objetivo es proponer una pauta de actuación que permita mejorar el pronóstico de esta patología. Métodos: Presentamos un caso de adenocarcinoma primario de uréter que afecta a un remanente ureteral tras una nefrectomía simple y hacemos una revisión de la literatura al respecto. Resultados: El paciente fue diagnosticado de adenocarcinoma primario de uréter tras el examen anatomopatológico y un estudio minucioso de extensión que permitiera descartar un tumor primario. Conclusión: El adenocarcinoma primario de uréter es una entidad muy poco frecuente lo que condiciona una pobre caracterización clínica y anatomopatológica. Puede presentarse como un dolor en flanco, disuria urgencia y/o hematuria macroscópica en pacientes con antecedentes de nefrectomía. Ante el hallazgo de un adenocarcinoma de uréter debemos descartar siempre que se trate de un tumor metastásico. En cuanto al tratamiento parece necesaria la exéresis completa del tumor y se puede intentar el tratamiento quimioterápico adyuvante con resultados inciertos (AU)

Aim: Adenocarcinomas of the upper urinary tract are very rare malignancies often related to primary genitourinary and extraurinary tumours. Primary adenocarcinomas are even rarer. There are no clinical guidelines for the management of primary ureteral adenocarcinoma. Our objective is to propose a management algoritm of this sort of tumours. Methods: We report a case of adenocarcinoma affecting a ureteral stump in a patient who previously underwent a nephrectomy.A review of literature is performed. Results: After the ureterectomy the pathologist diagnosed a ureteral adenocarcinoma. We performed an extension study in order to discard an extraurinary origin. Conclusions: Adenocarcinoma of the ureteral stump is a very rare malignancy. About the clinic and pathologic characterization, there is no an established reference due to the short number of previous reports. Clinical presentation may include previous nephrectomy, flank pain, dysuria, urgency and/or gross hematuria. It seem necessary the complete resection of the urinary tract when a nephrectomy is performed. Adjuvant chemotherapy can be employed with uncertain results (AU)