Evaluation of urinary IL-1alpha and IL-1beta in gravid females and patients with bacterial cystitis and microscopic hematuria.

OBJECTIVES: to determine IL-1alpha and IL-1beta levels in patients with bacterial cystitis, microscopic hematuria, and gravid females relative to a control group of normal subjects. METHODS: enzyme immunoassays were used to measure concomitantly urinary IL-1alpha and IL-1beta in clean catch urine samples from normal subjects (n = 31) and study patients (n = 46). All normal subjects and patients underwent urinalysis, urine culture, and urine creatinine level determination. Since the IL-1alpha assay was developed for serum, the utility of the assay for urine specimens was unknown. The key parameters of urine collection, processing and sample storage for IL-1alpha were evaluated in detail. RESULTS: mean values +/- SEM (pg/mg) for IL-1alpha/ Cr and IL-1beta/Cr were control group (0.25 +/- 0.10 and 0.17 +/- 0.06), bacterial cystitis (9.97 +/- 1.15 and 42.45 +/- 1.86), and microscopic hematuria (2.81 +/- 0.65 and 2.82 +/- 0.70). Differences in cytokine levels between the control group and patients with either bacterial cystitis or microscopic hematuria were statistically significant for both IL-1alpha/Cr (P < 0.026; P < 0.007, respectively) and IL-1beta /Cr (P < 0.0004; P < 0.014, respectively). IL-1beta/Cr correlates better with pyuria than IL-1alpha/ Cr (P = 0.02 vs P = 0.44). In gravid females, only IL-1alpha was significantly elevated relative to non-pregnant females (IL-1beta elevation approached statistical significance). Gravid females with positive urine cultures could not be distinguished from those with negative cultures based on either interleukin (P > 0.05). CONCLUSIONS: Significant elevations of IL-1alpha and IL-1beta occur in patients with bacterial cystitis and microscopic hematuria. Correlation between pyuria and cytokine elevation was stronger for IL-1beta than for IL-1alpha. Changes in IL-1alpha may reflect changes in the bladder epithelium rather than in the inflammatory leukocytes. The ability of IL-1alpha and IL-1beta to serve as markers for bacterial cystitis in gravid females is diminished due to high basal levels during pregnancy.

Conservative management of colon injury following percutaneous renal surgery.

OBJECTIVES: Colon injury during percutaneous renal surgery is rare and can result in significant morbidity. Our objective was threefold: (1) to identify risk factors for colon injuries; (2) to optimize prevention of such injuries; and (3) to devise a treatment strategy for optimal management of such colon injuries. METHODS: Between July 1990 and July 1995, all percutaneous renal procedures performed at three kidney stone centers were reviewed (Kaiser Permanente Medical Center, Los Angeles; Hospital of the Good Samaritan, Los Angeles; and University of California at San Francisco). In addition, a review of the pertinent literature was performed. RESULTS: Five patients who suffered colon injuries during percutaneous renal surgery were identified. All had undergone percutaneous nephrolithotomy, and all injuries were extraperitoneal. Mean age was 31 years (range 17 to 52). Three patients were considered lean, and the other two were of average body habitus. Four of 5 patients were male. Three injuries occurred on the left side and two on the right. Recognition of colon injury occurred postoperatively in 4 patients and intraoperatively in 1 patient. Presenting signs and symptoms included fever, fecaluria, abdominal pain, and leukocytosis. CONCLUSIONS: High risk patients for colon injuries are young, lean males with minimal retroperitoneal fat, in whom a retrorenal colon is more likely. High risk patients should be accessed with a more superior and medial puncture. Retroperitoneal colon injuries can be successfully managed conservatively with early recognition and appropriate drainage of the urinary and intestinal tracts. A treatment algorithm is presented.

Dimethyl sulfoxide does not trigger urine histamine release in interstitial cystitis.

OBJECTIVES: Dimethyl sulfoxide (DMSO), an agent that provides symptomatic relief in patients with interstitial cystitis (IC) works via an unknown mechanism. We investigated whether DMSO acts as a chemical stimulant of mast cell degranulation. METHODS: A radioimmunoassay (RIA) specific for histamine was used to test this hypothesis. Twelve women with strictly diagnosed IC were treated with intravesical instillations of DMSO. Treatments were repeated at varying intervals, and each patient received three to six treatments. Urine histamine levels were measured before and after each intravesical instillation of DMSO. Dilutional effects of DMSO were corrected for by conversion of urine histamine concentration to urine histamine:creatinine ratio. RESULTS: The RIA was unaffected by the addition of DMSO to urine. No consistent change in the urine histamine:creatinine ratio following DMSO instillation was found. Trend analysis revealed no trend in the histamine:creatinine ratio with time. CONCLUSIONS: The relief of symptoms reported in 50% to 77% of patients treated with intravesical DMSO is not related to detectable mast cell release of histamine. Other mechanisms of action must be investigated to explain the beneficial effect of this agent.