Lower pole kidney stones have been associated with poor shock wave lithotripsy (SWL) outcomes because of its location. However, the real impact of collecting system anatomy on stone clearance after ...SWL is uncertain. There is a lack of prospective well-controlled studies to determine whether lower pole kidney stones have inferior outcomes than nonlower pole kidney stones when treated with SWL.
We prospectively evaluated patients with a single kidney stone of 5-15 mm undergoing SWL from June 12 through January 19. All patients were subjected to computed tomography before and 3 months after the procedure. Demographic data (age, gender, and body mass index), stone features (stone size, stone area, stone density, and stone-skin distance-SSD), and collecting system anatomy (infundibular length and width, and infundibulopelvic angle) were recorded. Outcomes (fragmentation and stone clearance rates) were compared between lower pole and nonlower pole cases. Then, a multivariate analysis including all variables was performed to determinate which parameters significantly impact on SWL outcomes.
One hundred and twenty patients were included in the study. Mean stone size was 8.3 mm and mean stone density was 805 Hounsfield units. Overall stone fragmentation, success, and stone-free rates were 84.1%, 64.1%, and 34.1%, respectively. There were no significant differences in stone fragmentation (76.0%
71.4%;
= 0.624), success rate (57.6%
53.3%;
= 0.435), and stone-free rate (40.2%
35.7%;
= 0.422) in the lower
nonlower pole groups, respectively. On multivariate analysis, only stone density (
< 0.001) and SSD (
= 0.006) significantly influenced fragmentation. Stone size (
= 0.029), stone density (
= 0.002), and SSD (
= 0.049) significantly influenced kidney stone clearance.
Stone size, stone density, and SSD impact on SWL outcomes. Lower pole kidney stones have similar fragmentation and stone clearance compared with nonlower pole kidney stones.
Purpose
To assess the complication and stone-free rates of PCNL in patients with spinal cord injury (SCI) and to evaluate whether this population should be assigned a Guy’s stone score (GSS) of 4.
...Methods
A case–control study was conducted, and electronic charts were reviewed to search for patients with SCI, bladder dysfunction, and kidney stones who had undergone PCNL. Control cases were randomly selected from among patients with complete staghorn calculus (GSS = 4).
Results
One hundred and seventeen patients were included. Patients with SCI had a significant shorter operative time (119 vs. 141 min;
p
= 0.018). There were no significant differences between the groups in terms of the patients’ position, number of renal tracts, bleeding or transfusion rate; however, there was a significantly higher complication rate (23.1% vs. 7.8%;
p
= 0.009) and a longer hospital stay (5.8 vs. 3.1 days;
p
= 0.002) among patients with SCI. With regards to the stone-free rate in patients with different grades of GSS patients with SCI who had a GSS of 1 had a stone-free rate of 85.7%, while those with a GSS of 2, 3, or 4 had 50%, 50%, and 31.5%, respectively (
p
= 0.024). Only patients with a GSS of 4 in the SCI group had outcomes that were similar to those of control patients (31.5% vs. 31.6%).
Conclusion
Patients with SCI should not be automatically assigned GSS 4. Stone-free rate is related to stone burden in these patients, although they do show a higher complication rate and a longer hospital stay than non-neurological patients.
Purpose
To analyse patterns of stone disease online information-seeking behaviours in the United States and to correlate with urological literature publication aspects.
Methods
To compare Relative ...Search Volume (RSV) among different twelve preselected urologic keywords we chose “United States” as country and “01/01/2009–31/12/2018” as time range on Google Trends (GT). We defined “ureteroscopy” as a reference and compared RSV against it for each term. RSV was adjusted and normalized in a scale 0–100. Trend presence was evaluated by Mann–Kendall Test and magnitude by Sen’s Slope Estimator (SS). Weather influence on RSV was also investigated by comparison of the ten hottest versus ten coldest states. Pearson correlation analysis was performed between number of Pubmed publications and RSV for each term over time.
Results
We found an upward tendency (
p
< 0.01) for most terms. Higher temporal trends were seen for “kidney stone” (SS = 0.36), “kidney pain” (SS = 0.39) and “tamsulosin” (SS = 0.21). Technical treatment terms had little search volumes and no increasing trend. States with hotter weather showed higher mean RSV for “kidney stone” than colder ones. There was little correlation between GT and Pubmed for most terms, with the exception of “kidney stone” (
R
= 0.89;
p
< 0.01), “URS” (
R
= 0.81;
p
< 0.01), and “laser lithotripsy” (
R
= 0.74;
p
= 0.01).
Conclusion
There was a significant increase in online search for medical information related to stone disease. Citizens tend to look for generic terms related to symptoms or the disease itself. States with hotter weather show higher RSV than colder states. There is a discrepancy between public and medical community medical terms.
ABSTRACT Introduction To present the current practice patterns on percutaneous nephrolithotomy (PCNL) in a developing country. Materials and Methods A survey was offered to Brazilian urologists ...during the II International Endourology Symposium held in Sao Paulo, in 2015. The first seven questions were related to demographic data while the 20 remaining were directed to urologists who performed PCNL. Results From 250 participants, 100 replied to the survey, 81% performed PCNL and 60.4% of performers had been in practice for less than 15 years. Eighty-one percent were trained in the prone position and 64% in supine. PCNL was learned during the residency in 66.7% and 2.5% had fellowship training. Prone position was the preferred decubitus for simple or complex calculi, though for obese patients there was no difference. Younger surgeons prefer supine while older surgeons prefer prone. The access was obtained by the surgeon in all cases, 96.3% use fluoroscopy and 3.7% prefer ultrasonography. Forty-seven percent use ultrasonic lithotripters and 4.1% laser. For kidney drainage, 71.6% place a nephrostomy tube. Double J stent is left in 77%. The postoperative image method was CT for 50%. Colonic injury was reported by 25%, predominantly in the senior group without statistically difference between positions. Conclusions From a selected group of urologists, we observe that Brazilian urologists usually gain their own access for PCNL guided by fluoroscopy. They predominantly prefer the prone position, use fascial dilators, ultrasonic lithotripters and place a nephrostomy tube when exiting the kidney. Fellowship programs, ultrasonography, flexible nephoscopy and tubeless procedures could be encouraged.
•The EW projects to unexpected targets, including the central nucleus of the amygdala and the lateral hypothalamic area.•The EW projects fibers that putatively synapse with CRF- and MCH-expressing ...neurons at specific targets.•The EW connections may explain its participation in the stress response, feeding behavior, addiction and nociception.
The oculomotor accessory nucleus, often referred to as the Edinger–Westphal nucleus EW, was first identified in the 17th century. Although its most well known function is the control of pupil diameter, some controversy has arisen regarding the exact location of these preganglionic neurons. Currently, the EW is thought to consist of two different parts. The first part termed the preganglionic EW—EWpg, which controls lens accommodation, choroidal blood flow and pupillary constriction, primarily consists of cholinergic cells that project to the ciliary ganglion. The second part termed the centrally projecting EW—EWcp, which is involved in non-ocular functions such as feeding behavior, stress responses, addiction and pain, consists of peptidergic neurons that project to the brainstem, the spinal cord and prosencephalic regions. However, in the literature, we found few reports related to either ascending or descending projections from the EWcp that are compatible with its currently described functions. Therefore, the objective of the present study was to systematically investigate the ascending and descending projections of the EW in the rat brain. We injected the anterograde tracer biotinylated dextran amine into the EW or the retrograde tracer cholera toxin subunit B into multiple EW targets as controls. Additionally, we investigated the potential EW-mediated innervation of neuronal populations with known neurochemical signatures, such as melanin-concentrating hormone in the lateral hypothalamic area LHA and corticotropin-releasing factor in the central nucleus of the amygdala CeM. We observed anterogradely labeled fibers in the LHA, the reuniens thalamic nucleus, the oval part of the bed nucleus of the stria terminalis, the medial part of the central nucleus of the amygdala, and the zona incerta. We confirmed our EW–LHA and EW–CeM connections using retrograde tracers. We also observed moderate EW-mediated innervation of the paraventricular nucleus of the hypothalamus and the posterior hypothalamus. Our findings provide anatomical bases for previously unrecognized roles of the EW in the modulation of several physiologic systems.
The optimal patient positioning for percutaneous nephrolithotomy (PCNL) based on the complexity of stone burden is not yet defined. Thus, we aimed to evaluate the intraoperative parameters, ...effectiveness and complications of patients undergoing PCNL between the endoscopic-guided prone split-leg PCNL (ePSL) and the supine PCNL by stratifying patients according to Guy's stone score (GSS).
A retrospective chart review was conducted of patients undergoing PCNL at two high-volume tertiary referral centers. At one center, patients underwent PCNL using the ePSL technique, while at the second center, patients underwent PCNL in supine. Patient demographics and stone characteristics, operative details, complications and effectiveness were compared between groups. The impact of obesity was also investigated.
Of 830 subjects, a total of 449 (54%) underwent PCNL in ePSL and 381 (46%) in supine. The ePSL group had a greater mean age and body mass index. No statistical differences were found in gender, serum chemistry and Charlson comorbidity index. After stratifying patients by GSS, the differences in baseline stone burden between PSL and supine lost significance and both groups could be compared. Complications were not statistically different between both groups. Univariate analysis demonstrated that multiple tracts and lower pole access were more prevalent in supine. In addition, for GSS1-3, ePSL was correlated with reduced operative time, radiation exposure, length of hospital stay and need for secondary procedure. Multivariate analysis correlated ePSL with lower radiation exposure and need for secondary procedures (p = 0.01). In comparison to the whole trial population, the same tendencies were appreciated for obese cohort.
This is the first report focusing on the performance differences between ePSL and supine PCNL stratified by GSS. Both techniques are safe, with a low rate of complications. For GSS1-3, ePSL reduces radiation exposure and requires less need for both multiple access and secondary procedure.
Penile refracture is an exceedingly rare event, with very few published studies. To the best of our knowledge, this is the first documented case in the literature of penile fracture with 3 same-site ...recurrences.
To describe the case of a 25-year-old Caucasian man with recurrent penile fracture ultimately treated with resuture and patch reinforcement.
Patient history (clinical and surgical) and literature review.
After the 3rd same-site recurrence, patch reinforcement over the sutured area was performed. The patient had an uneventful recovery and no recurrences to date.
There is no evidence indicating the superiority of non-absorbable sutures. Bovine pericardium reinforcement over the sutured area was used to minimize the chance of another recurrence. More studies are necessary to investigate its safety and efficacy in this scenario.
Nascimento B, Guglielmetti GB, Miranda EP, et al. Recurrent Penile Fracture—Case Report and Alternative Surgical Approach. Sex Med 2018;6:263–266.
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