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IntroductionUrinalysis (UA) in the emergency setting for patients with nephrolithiasis produces potentially confusing results leading to treatment of presumed urinary tract infections (UTIs). Our objective was to evaluate the use of antibiotics in patients with nephrolithiasis in a large network of emergency departments (EDs).MethodsA retrospective analysis of all ED visits associated with an ICD-9 diagnosis of nephrolithiasis and a CT scan between 2010 and 2013 was performed. Urinalysis data, the use of IV and PO antibiotics during the ED visit and at discharge were assessed. The presence of fever, elevated serum WBCs, >5 WBCs per hpf, and/or dip positive nitrites were used as appropriate criteria for antibiotic use.ResultsUrinalysis data were available for 3,518 (70%) of 5,035 patients with an ED diagnosis of nephrolithiasis and CT imaging. Of these visits, 237 patients had positive nitrites (6.7%) and 864 had >5 WBCs per hpf (24.6%) with 158 (4.5%) having both findings for a total of 943 patients. Intravenous antibiotics were given to 244 patients (25.9%) and oral antibiotics were given to 629 patients (66.7 %) with positive UA findings. Of the 2,440 patients with a negative UA and no leukocytosis or fever, 86 patients (3.5%) received IV antibiotics and 533 patients (21.8%) received PO antibiotics upon discharge.ConclusionsProper treatment of nephrolithiasis in the ED includes the screening and diagnosis of concomitant UTIs. However, correct interpretation of UA studies is vital to the correct implementation of antibiotic therapy. This study suggests that 1/3 of patients were undertreated and 21.8% were over-treated.

Introduction: Hybrid guidewires are commonly used in urology due to the advantage of an atraumatic hydrophilic tip, which facilitates negotiating tight areas, coupled with an unkinkable nitinol core shaft that is easy to work over due to the Teflon coating. Our aim was to compare the physical and mechanical properties of five commercially available hybrid guidewires to assess their characteristics and functionality. Methods: In vitro testing was performed on the following straighttipped 0.035 inch guidewires: Sensor™ (Boston Scientific), Solo™ Plus (Bard), UltraTrack (Olympus), Rio Tracer™ (Rocamed), and Motion™ (Cook). We evaluated characteristics impacting function (tip flexibility, shaft stiffness, lubricity) and safety (perforation force). Measurements included tip flexibility, lubricity, shaft buckling, and force required to perforate a sheet of aluminum foil. Results: The Motion had the highest tip-bending force (p<0.00001). The Rio Tracer had the stiffest shaft (p<0.00001), followed by the Solo Plus and the Motion, which were significantly stiffer than the Sensor and UltraTrack (p<0.00001). The Solo Plus and UltraTrack had the greatest perforation force (p=0.00023), and the Rio Tracer had the lowest perforation force (p=0.016) when compared to the Sensor. There was no significant difference in frictional force between the five guidewires (p=0.1516). Conclusions: The Solo Plus and UltraTrack required the greatest force to perforate, which conveys a higher safety margin. The RioTracer is the stiffest guidewire, which may be beneficial for instrument insertion with the tradeoff of having a lower perforation force. The clinical significance of higher tip-bending forces (unfavourable) and higher shaft-bending forces (favourable) deserve further investigation. [ABSTRACT FROM AUTHOR]

Introduction: To determine if markers of kidney injury correlate with urinary oxalate excretion. If so, such biomarkers might be early predictors of oxalate nephropathy. Gastric bypass surgery for obesity is known to be associated with postoperative hyperoxaluria, which can lead to urolithiasis and kidney damage., Materials and Methods: Patients were recruited from four large academic centers > 6 months following completion of gastric bypass surgery. Patients provided a spot urine sample for analysis of three markers of kidney injury: 8-iso-Prostaglandin F2 α, N-acetyl- β -D-Glucosaminidase, and Neutrophil gelatinase-associated lipocalin. Patients also provided 24 hour urine samples for stone risk analysis., Results: A total of 46 study patients provided samples, the average age was 48.4 +/- 11.3. There were 40 women and 6 men. There was no difference in the level of any of the three inflammatory markers between the study group and the reference range generated from healthy non-hyperoxaluric subjects. Neither oxalate excretion nor supersaturation of calcium oxalate correlated with any of the injury markers. There was no difference noted between those with hyperoxaluria (n = 17) and those with normoxaluria (n = 29) with respect to any of the injury markers., Conclusions: Though hyperoxaluria was common after bypass surgery, markers of kidney injury were not elevated after surgery. No correlation was found between urine oxalate excretion and any of the injury markers.