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INTRODUCTION AND OBJECTIVE:Percutaneous nephrolithotomy (PCNL) is a combination of two procedures that first requires the establishment of percutaneous renal access followed by endoscopic stone fra...

INTRODUCTION AND OBJECTIVES:Ureteroscopic laser lithotripsy (URSL) has become the most common form of surgical management of kidney stones in the United States. Intraoperative residual stone burden...

INTRODUCTION AND OBJECTIVES:There are limited data regarding the optimal management of clinically node-positive (cN+) bladder cancer. Although the mainstay of treatment is chemotherapy, it is uncle...

larger. Analysis for predictors of a lesion becoming RBþ demonstrated that any lesion growth on MRI was a significantly associated with a lesion being RBþ (p1⁄40.012, odds ratio 1⁄4 4.8, 95% CI [1.5, 15.4]). Initial MRI suspicion score, upgrading of MRI suspicion score, initial lesion size < 0.7 cm, and MRI parameters were not significantly associated. CONCLUSIONS: Targeted biopsy negative lesions almost always were benign on serial biopsy. When a lesion was RBþ the vast majority demonstrated low risk disease. Biopsy negative lesions should be re-sampled if they increase in size at an interval of 2 years.

INTRODUCTION AND OBJECTIVES: The use of rectal swab cultures to guide antimicrobial prophylaxis for transrectal ultrasound (TRUS)-guided prostate biopsy has been suggested as a way to reduce infectious complications from antibiotic-resistant microorganisms. We assessed the incidence of fluoroquinolone resistance in men undergoing prostate biopsy and evaluated the effect of culture-directed prophylaxis on the risk of infectious complications after prostate biopsy. METHODS: All men who received prostate biopsies 2/1/13 e 10/31/13 at our institution were included in an IRB approved retrospective cohort study. At the discretion of the attending physician, patients received either a pre-procedural rectal swab and culture to guide antimicrobial prophylaxis, or routine prophylaxis with a fluoroquinolone antibiotic. Basic patient demographic and clinical information were collected, as well as data on any infectious complications within 30 days of biopsy. Fisher’s exact test and Welch’s t-test were used for statistical analysis. Confounding variables were controlled for with a multivariate logistic regression model. RESULTS: 347 patients were included in the study. Of these, 205 patients received a pre-procedure rectal swab culture and 142 did not. Average patient age was 62.6 and 64.4 years, respectively (p1⁄40.04). There was no difference in mean PSA value (p1⁄40.30) or age-adjusted Charlson comorbidity score (p1⁄40.10) between the two groups. 13.1% of rectal cultures demonstrated fluoroquinoloneresistant microorganisms. Infectious complications occurred in 0.9% of the rectal swab group and 2.9% of the control group (p1⁄40.16), which included hospital admissions for bacteremia, pyelonephritis, sepsis, or septic shock. Rectal swab culture-directed antibiotics were associated with a decreased risk for post-biopsy infection (RR 0.17, 95% CI 0.02-1.53). A multivariate logistic regression model demonstrated a decreased risk of infection if a rectal swab culture was done (p1⁄40.11). CONCLUSIONS: The incidence of fluoroquinolone resistance is relatively high in our patient population. Overall, infection rates after prostate biopsy are low, with a non-significant reduction in incidence of post-biopsy infection for patients receiving rectal swab-directed antimicrobial prophylaxis. Though not statistically significant, these differences remain clinically significant, given the severity of observed infectious complications.

Theoretically patients with cystinuria compliant with medical treatment should undergo fewer surgical procedures than those noncompliant with treatment. We describe a single urologist's experience (SYN) with the effects of medical management on the number of surgical interventions required in patients with cystinuria treated at our metabolic stone clinic (MSC).The records of 20 patients with cystine stones seen at our MSC (mean followup of 42.5 months) were evaluated. The number of surgical interventions (endourology or open surgery) during followup were recorded as surgical events. Patients were placed into a compliant or noncompliant category based on their attendance record at scheduled appointments at our MSC and whether they adhered to the prescribed medical regimen by report. Patients were classified in an active disease category if recent imaging revealed a clinically significant stone burden greater than 3 mm. Statistical analysis of the number of surgical events for stone-free patients compliant with treatment versus noncompliant was conducted (Student's t test).Of the 20 patients 11 were categorized as compliant and 9 as noncompliant. Of the compliant patients the average number of surgical events was 1.0 per patient versus 4.0 in the noncompliant group (p0.05). Of the 11 compliant patients 8 (73%) were stone-free compared to 3 (33%) in the noncompliant group.The majority of our patients with cystinuria compliant with treatment underwent a significantly fewer number of surgical procedures per year than those noncompliant with treatment. Active medical management in patients with cystinuria compliant with treatment decreases the incidence of surgical interventions.

and past history of ureteral stone. The association with CT parameters of stone including diameter (D), length (H), volumetric stone burden (VSB; D H 5 / 6), estimated stone location (ESL; number of axial cut images between stone and UVJ), tissue rim sign (RS; 0-3), perinephric edema (0-3), hydronephrosis (0-3), and Hounsfield unit (HU) were also analyzed. Then a logistic regression model was developed using these variables to estimate the stone-free rate after URSL. RESULTS: The stone-free rate of URSL was 85.7% (203/237). Univariate analysis found that stone diameter, length, VSB, ESL, HU and RS significantly affect the stone-free rate (p 0.000, 0.000, 0.003, 0.000, 0.005, 0.000, respectively). Multivariate analysis indicated that stone diameter (HR 1.165, p 0.005), ESL (HR 1.074, p 0.001), and RS (HR 4.635, p 0.009) significantly affect the stone-free rate. Predictive model by logistic regression analysis for stone-free rate after URSL was defined as follows: stone free rate 1/[1 exp{6.146 0.153(D) 0.071(ESL) 1.534(RS)}] with AUC 0.825 from ROC curve. Internal validation showed that stone-free rate concordance was 0.774. CONCLUSIONS: Present study demonstrated that CT-measured parameters including stone diameter, ESL and RS are independent factors affecting URSL outcome. A CT-based predictive model using these factors helps to estimate stone-free rate after URSL in individual patients and facilitates treatment planning.

Studies suggest that HU values on non-contrast computerized tomography may predict the ability to fragment urinary calculi. We determined whether the HUs of in vivo urinary stones could be used to predict the stone-free rates after extracorporeal shock wave lithotripsy.We evaluated 50 patients who underwent extracorporeal shock wave lithotripsy for 5 to 10 mm. upper urinary tract stones. Chemical analyses and HU calculations were performed for each stone and posttreatment radiographic assessment categorized patients into a stone-free or a residual stone group. Statistical analysis was performed using the Student t test to compare mean HU values in the 2 groups.Of the patients 32 (64%) were stone-free and 18 (36%) had residual stones. Mean values +/- SEM for the stone-free and residual stone groups were significantly different (551.20 +/- 46.66 versus 926.20 +/- 51.42 HU, p0.0001). A total of 30 calculi (60%) were located in the ureter, including 21 in the stone-free group and 9 in the residual stone group with a mean value of 505.10 +/- 46.66 and 888.70 +/- 102.00 HU, respectively, which was significantly different (p = 0.0005). A total of 20 calculi (40%) were located in the kidney, including 11 in the stone-free group and 9 in the residual stone group with a mean value of 558.40 +/- 62.38 and 905.10 +/- 61.49 HU, respectively, which was significantly different (p = 0.001).These findings suggest that HU measurement of urinary calculi on pretreatment non-contrast computerized tomography may predict the stone-free rate. This information may be beneficial for selecting the preferred treatment option for patients with urinary calculi.