Evaluating the definition of "stone free status" in contemporary urologic literature.

OBJECTIVE: There is no standardized definition of stone free after renal stone surgery. The lack of standardization prompted a review of the current urologic literature, to assess the definitions of stone free status, and how imaging is used to determine stone free status. METHODS: A literature search on PubMed for the MeSH terms for percutaneous nephrolithotomy (PCNL), ureteroscopy with lithotripsy, shock wave lithotripsy (SWL), and laser lithotripsy, published in English between January 2007 and January 2010 was performed. Case reports, articles not evaluating stone free outcomes, and review articles were excluded. Articles were evaluated for the treatment modality, definition of stone free status, and the imaging modality employed to determine stone free status. RESULTS: This search yielded 417 articles of which 249 met inclusion criteria. Stone free was defined in 169 articles (68%). The most common definition of stone free was "no stones" (47%), but a total of seven different definitions were encountered. The most common treatment modality was PCNL (47%), followed by SWL (33%), and URS (13%). The most common detection modality was KUB alone (28%), the second most common being KUB and US combined (22%). CONCLUSIONS: Nearly one-third of articles evaluating surgical management of urinary calculi do not define stone free status; when stone free is defined, there is wide variation as to that definition. Furthermore, vast differences exist in the type of imaging used to define stone free status. The urologic community should standardize the reporting of stone free outcomes in the urologic literature.

Monitoring the serological proteome: the latest modality in prostate cancer detection.

PURPOSE: Various strategies have recently emerged to improve the diagnostic prediction of prostate cancer (CaP). One such strategy includes the mass profiling of serum protein fractions selectively adsorbed onto chemically modified probes. In the current study we further validated this approach, while offering a more versatile, less expensive and yet equally predictive alternative to existing technologies. MATERIALS AND METHODS: A solid core lipophilic C-18 resin was used to extract and enrich the low molecular weight protein fraction from patient serum for further analysis by mass spectrometry. Mass spectra generated from a 48 patient training set were data mined using multivariate analysis to identify diagnostically significant protein peaks. These peaks were then used to test a blinded study set comprising 168 patients with common statistical algorithms and commercially available software packages. RESULTS: A total of 36 peaks generated from the training set were used to test the combined set of 168 serum samples obtained from 98 healthy individuals and 70 patients with CaP. We report a sensitivity of 94.1% and a specificity of 99.0% with 1 false-positive, 4 false-negative and 5 nondiagnosed cases. CONCLUSIONS: Our results further indicate that mass profiling of serological proteins provides a means for the accurate detection of CaP. In addition, our approach was found to be superior to chip based protocols, generating rich, sharp, highly reproducible spectra attainable in a high throughput manner and at minimal cost. This technique is also scaleable for subsequent protein characterization using multidimensional protein identification technologies. Finally, analyses of mass spectra with commercially available statistical applications was found to be highly effective in generating highly discriminatory m/z values for CaP diagnosis.

Priapism from quetiapine overdose: first report and proposal of mechanism.

We report a case of priapism occurring after an overdose of the newly approved atypical antipsychotic quetiapine. A review of its previously published receptor-binding studies suggests that alpha-adrenergic blockade may be the responsible mechanism. To our knowledge, this is the first report of priapism associated with quetiapine, and we recommend the inclusion of priapism in its list of potential adverse effects in cases of overdose.

Plasmacytoma of the urethra treated with transurethral resection and radiotherapy.

Plasmacytoma, which is a localized malignant plasma cell tumor, occurs rarely and is found mostly in the upper airways of older patients. Two urethral plasmacytomas have been reported, 1 of which was a primary lesion. We describe a primary plasmacytoma of the urethra in a 23-year-old woman who had been exposed to diethylstilbestrol in utero. The patient underwent transurethral resection of the tumor and radiation therapy and has been free of disease for more than 10 years.

Infertility in an XX male.

A case of an infertile male subject with 46XX female karyotype is reported. A testicular biopsy revealed hyalinized tubules with Sertoli cells and marked interstitial cell hyperplasia. Chromosomal studies showed the presence of 46 chromosomes with an XX sex chromosome constitution, confirmed with trypsin banding. XX male subjects present an interesting diagnostic problem and need to be differentiated from XXY male subjects with Klinefelter's syndrome. The clinical features of this rare syndrome are discussed and the literature is reviewed.

Idiopathic pelviureteric varices.

Pelviureteric varices are well-documented sequelae of renal vein thrombosis, but there have been only 10 prior reports of idiopathic renal vein varicosities. Herein we report 3 more cases and review the literature. Two thirds of the patients presented with hematuria; one-fourth had flank pain, and one-third had saphenous vein varicosities. Pyelographic findings include scalloped deformities of the upper ureter and pelvis with displacement and intraluminal filling defects. The diagnosis may be suspected from the excretory urogram, but venography is definitive. Excision and ligation of the varicose veins were curative in all but 3 patients who required nephrectomy for life-threatening hemorrhage.

Radiolucent defects within renal pelvis.

Radiolucent filling defects within the renal pelvis are common findings in diagnositc urography, and because of their myriad causes the diagnostician is often faced with a challenging problem. Several of the more unusual causes of renal pelvis filling defects are described and their diagnosis, pathophysiology, and therapy discussed.

Paraurethral cysts in female neonate.

Paraurethral cysts in the female neonate are uncommon lesions. All reported cases have either ruptured spontaneously or responded to simple marsupialization. However, complete urologic evaluation is mandatory because they simulate ectopic ureteroceles in appearance. Herein is reported our experience with 5 patients. The etiology, embryogenesis, natural history, differential diagnosis, and treatment are discussed.

Arteriovenous aneurysm of kidney after open renal biopsy.

Renal arteriovenous fistula following percutaneous renal biopsy is being reported frequently in the literature. For this reason, open renal biopsy has gained popularity as a safer alternative procedure. We present a case of a large arteriovenous fistula seen two years after open renal biopsy. The presentation was highly atypical, mimicking an acute gastrointestinal event, rather than sudden hemorrhage in a previously asymptomatic fistula.

Chemolysis of residual stone fragments after extensive surgery for staghorn calculi.

Chemical dissolution of residual stone fragments was attempted in twelve instances via nephrostomy tube irrigation. Appropriate solutions containing either hemiacidrin or sodium bicarbonate were used for struvite and uric acid stones, respectively. Precautions were taken to prevent and recognize outflow obstruction and urinary infection. Seventy-five per cent of the stones so treated were completely dissolved, and there were no major complications. The incidence of retained stones, natural history, and indications for chemical dissolution are reviewed.

Reversible hydronephrosis in the neonate with urinary sepsis.

Hydroureteronephrosis without vesicoureteral reflux or lower-urinary-tract obstruction is uncommon in infants. There has been considerable interest in and controversy over the cause and management of this entity. We have cared for three neonates with severe hydroureteronephrosis after acute urinary tract infections, who were treated without operation.