Impact of Retained Ureteral Stents on Long-Term Renal Function.

INTRODUCTION: The current literature does not provide any data regarding the rate of chronic kidney disease associated with retained ureteral stents. Thus, we determined the rates of major morbidities such as chronic kidney disease and severe urinary tract infection caused by retained stents. METHODS: We retrospectively reviewed all records of patients at our institution who underwent ureteral stent placement and ureteral stent removal between January 2003 and October 2016. Of these patients 34 were diagnosed with a retained ureteral stent defined as a stent in place for more than 6 months. We selected 120 patients with a nonretained stent during this time frame to serve as a control group. Our primary end point was the rate of chronic kidney disease after ureteral stent removal. RESULTS: Median duration of ureteral stent in situ was 13.7 months (range 6.4 to 146.1) in the retained group vs 32 days (range 2 days to 5.1 months) in the control group. Of the retained group 9 patients (26.47%) with normal renal function before stent placement were diagnosed with chronic kidney disease after stent removal vs 4 (3.33%) in the control group (OR 8.64, 95% CI 2.05-41.9, p = 0.0009). CONCLUSIONS: Patient counseling and measures to ensure compliance with followup are of paramount importance after stent placement as patients with a retained ureteral stent are at risk for chronic kidney disease despite removal of the retained stent.

Occlusion of bilateral dorsal penile arteries resulting in glans necrosis in an obese male truck driver.

Ischemic penile gangrene is an uncommon urologic condition associated with significant morbidity. Etiology of the disease is due to vasculogenic ischemia of the penile tissue. Presented are a series of images from a case of a 51-year-old morbidly obese male truck driver with idiopathic ischemic penile gangrene. The patient was evaluated with penile angiography and treated with urinary diversion via suprapubic catheter placement and serial debridement of the necrotic tissue.

Suprapubic catheter placement through ileal mesentery causes mechanical small bowel obstruction six years later in a female patient with turners syndrome.

Percutaneous suprapubic cystostomy (SPC) is a procedure performed to manage urinary retention when urethral catheterization is contraindicated or to improve the quality of life in cases such as neurogenic bladder. Although a simple procedure, it is associated with serious complications, increasing the morbidity and mortality. This case study demonstrates a delayed presentation of small bowel obstruction caused by a suprapubic catheter traversing through the ileal mesentery in a patient with no prior bowel surgeries. Few cases report this complication and this is possibly the first case to be reported six years after SPC placement.

Citrus auraptene suppresses cyclin D1 and significantly delays N-methyl nitrosourea induced mammary carcinogenesis in female Sprague-Dawley rats.

BACKGROUND: Breast cancer is a major problem in the United States leading to tens of thousands of deaths each year. Although citrus auraptene suppresses cancer in numerous rodent models, its role in breast cancer prevention previously has not been reported. Thus, our goal was to determine the anticarcinogenic effects of auraptene against breast cancer. METHODS: The effects of auraptene on cell proliferation of MCF-7 and MDA-MB-231 human breast carcinoma cells in culture was assessed by measuring metabolism of a substrate to a formazan dye. Dietary effects of auraptene on tumor incidence, multiplicity and latency were studied in the N-methyl nitrosourea (MNU) induced mammary carcinogenesis model in female Sprague Dawley rats. The concentration of auraptene in rat tissues was analyzed by reverse phase HPLC. Cyclin D1 expression in MCF-7 cells and rat tumors was measured by western blot. RESULTS: Auraptene (500 ppm) significantly delayed median time to tumor by 39 days compared to the MNU only group (p < 0.05, n = 24-26). Auraptene (10 microM) reduced Insulin like Growth Factor-1 (IGF-1, 10 ng/mL)-induced cyclin D1 expression by 40% in MCF-7 cells. In comparison, western blot analysis of rat mammary tumors (n = 10 per group) confirmed that auraptene (500 ppm) significantly reduced (p < 0.05) cyclin D1 expression by 49% compared to the MNU only group. Analysis of rat mammary tissue extract by HPLC with fluorescence detection indicated an average concentration (means +/- S.E.) of 1.4 +/- 0.5 microM and 1.8 +/- 0.3 microM in the normal mammary glands of the auraptene 200 ppm and 500 ppm groups, respectively. The concentration (means +/- S.E.) of auraptene in the mammary tumors of the auraptene 200 ppm group was 0.31 +/- 0.98 microM. CONCLUSION: Overall, these observations suggest that the predominant effect of auraptene was to delay the development of tumors possibly through the suppression of cyclin D1 expression. These results point to the potential chemopreventive effects of auraptene in mammary carcinogenesis.