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Antibiotics can alter the gut microbiome (GMB), which may be associated with stone disease. We sought to determine the effect that antibiotics have on the GMB, urine ion excretion and stone formation in genetic hypercalciuric stone-forming (GHS) rats. 116th generation GHS rats were fed a fixed amount of a normal calcium (1.2%) and phosphate (0.65%) diet, and divided into three groups (n = 10): control (CTL) diet, or supplemented with ciprofloxacin (Cipro, 5 mg/day) or Bactrim (250 mg/day). Urine and fecal pellets were collected over 6, 12 and 18 weeks. Fecal DNA was amplified across the 16S rRNA V4 region. At 18 weeks, kidney stone formation was visualized by Faxitron and blindly assessed by three investigators. After 18 weeks, urine calcium and oxalate decreased with Bactrim compared to CTL and Cipro. Urine pH increased with Bactrim compared to CTL and Cipro. Urine citrate increased with Cipro compared to CTL and decreased by half with Bactrim. Calcification increased with Bactrim compared to CTL and Cipro. Increased microbial diversity correlated with decreased urinary oxalate in all animals (R = − 0.46, p = 0.006). A potential microbial network emerged as significantly associated with shifts in urinary pH. Bactrim and Cipro differentially altered the GMB of GHS rats. The Bactrim group experienced a decrease in urine calcium, increased CaP supersaturation and increased calcification. The GMB is likely a contributing factor to changes in urine chemistry, supersaturation and stone risk. Further investigation is required to fully understand the association between antibiotics, the GMB and kidney stone formation. [ABSTRACT FROM AUTHOR]

To evaluate the clinical safety profile for the use of gold nanoshells in patients with human prostate cancer. This follows on the nonclinical safety assessment of the AuroShell particles reported previously. Twenty-two patients, with biopsy diagnosed prostate cancer, underwent nanoshell infusion and subsequent radical prostatectomy (RRP). Fifteen of these patients had prostates that were additionally irradiated by a single-fiber laser ablation in each prostate hemisphere prior to RRP. Patients in the study were assessed at 9 time points through 6 months postinfusion. Adverse events were recorded as reported by the patients and from clinical observation. Blood and urine samples were collected at each patient visit and subjected to chemical (16 tests), hematological (23 tests), immunological (3 tests, including total PSA), and urinalysis (8 tests) evaluation. Temperature of the anterior rectal wall at the level of the prostate was measured. The study, recorded 2 adverse events that were judged attributable to the nanoparticle infusion: (1) an allergic reaction resulting in itching, which resolved with intravenous antihistamines, and (2) in a separate patient, a transient burning sensation in the epigastrium. blood/hematology/urinalysis assays indicated no device-related changes. No change in temperature of the anterior rectal wall was recorded in any of the patients. The clinical safety profile of AuroShell particles is excellent, matching nonclinical findings. A recent consensus statement suggested that the published literature does not support a preference for any ablation technique over another.1 Now that clinical safety has been confirmed, treatment efficacy of the combined infusion plus laser ablation in prostate will be evaluated in future studies using imaging modalities directing the laser against identified prostate tumors. [ABSTRACT FROM AUTHOR]

Urinary stone disease (USD) is a major health concern. There is a need for new treatment modalities. Recently, our group provided evidence for an association between the GMB composition and USD. The accessibility of the Gut Microbiome (GMB) makes it an attractive target for investigation and therefore, in these studies we have evaluated the extent to which the whole gut microbial community in fecal transplants can affect urinary stone risk parameters in an animal model. Fresh fecal pellets were collected from Zucker lean rats, homogenized in PBS (100 mg/mL), filtered through a 70 μm strainer and then orally gavaged into C57BL/6NTac germ‐free mice. Twenty‐four hours urine collections and GMB analysis were performed over time for 1 month. Kidney and gut tissue were harvested from transplanted mice for western blot analysis of expression levels of the Slc26a6 transporter involved in oxalate balance. Urinary calcium decreased after fecal transplant by 55% (P < 0.001). Urinary oxalate levels were on average 24% lower than baseline levels (P < 0.001). Clostridiaceae family was negatively correlated with urinary oxalate at 4 weeks after transplant (r = −0.83, P < 0.01). There was a 0.6 unit average increase in urinary pH from a baseline of 5.85 (SE ± 0.028) to 6.49 (SE ± 0.04) (P < 0.001) after transplant. There was a concomitant 29% increase in gastrointestinal alkali absorption (P < 0.001) 4‐weeks after fecal transplant. Slc26a6 expression increased by 90% in the cecum after transplant. Our results suggest that the gut microbiome may impact metabolism, alters urinary chemistry, and thereby may influence USD; the accessibility of the GMB can potentially be leveraged for therapeutic interventions. This paper represents a very early publication in this field of urology suggesting that the GMB can alter urinary stone parameters important for stone risk. [ABSTRACT FROM AUTHOR]

Introduction: Multiple studies have concluded that ambulatory percutaneous nephrolithotomy (aPCNL) is safe. However, selection criteria remain vague and no investigators have assessed the practicality of using various post-procedural drainage strategies in the ambulatory setting. In this study we establish a set of inclusion and exclusion criteria for aPCNL, compare outcomes between aPCNL patients and those admitted following PCNL, and incorporate a variety of "exit" strategies including Double-J stent, ureteropelvic junction (UPJ) stent and totally tubeless techniques. Methods: We developed inclusion and exclusion criteria to determine patient eligibility for aPCNL. Between January 2014 and December 2016, 52 out of 145 patients met criteria for aPCNL and 47 of these patients were ultimately discharged on the same day. Forty-seven of the remaining 98 patients who were admitted following PCNL were randomly selected as a control group. Primary outcomes included stone-free status, emergency department (ED) visits and hospital readmissions within the 6-week post-operative period. Statistical analysis was performed using Student's t-tests, chi square tests, and Fischer's exact tests. Results: Both groups had similar age (P = 0.91), sex (P = 0.68), body mass index (P = 0.91), and stone burden (P = 0.12). Patients in the ambulatory group had a lower Charlson Comorbidity score (aPCNL CCS = 0.11, inpatient PCNL CCS = 0.62, P = 0.002). Seventy three percent of ambulatory patients and 62% of standard PCNL patients had no residual stone burden 6 weeks following PCNL (P = 0.33). The average residual stone fragment in our ambulatory and standard PCNL group was 3.5 and 3.2 mm, respectively. Five patients (11%) from the aPCNL group and 4 (9%) from the standard PCNL group presented to the ED (P = 0.76). One aPCNL (2%) and three standard PCNL (6%) patients were re-admitted to the hospital (P = 0.62). Conclusions: In this study we establish specific inclusion and exclusion criteria for aPCNL. Using these criteria we then demonstrated the practicality of using various exit strategies to facilitate aPCNL. Future randomized control trials would be beneficial in confirming the safety and efficacy of aPCNL in select patients. [ABSTRACT FROM AUTHOR]

Objective: To characterize the changes in urine composition associated with increasing severity of diabetes, we analyzed urine composition relative to glycated hemoglobin (HbA1c) and treatment strategy in a largely minority population.Methods: Patients treated for kidney stones between 2001 and 2013 at a single tertiary institution and had 24-hour urine collections were included in the study. Patients with type 1 diabetes or taking either thiazide diuretics or alkalinizing agents were excluded. Analysis was performed in IBM SPSS Statistics version 20 using multivariate regression, and Kruskal-Wallis testing was used.Results: Nine hundred fifty-five patients were included in this study-268 (28%) with type 2 diabetes mellitus, of whom 53 (19.8%) used insulin. Patients with diabetes had lower urine pH, calcium, and phosphate when compared with the control group, but no significant differences were found between the diabetes groups. Multivariate analysis found that HbA1c had a positive correlation with citrate (P = .008), creatinine (P = .037), urine volume (P = .044), and a trend toward a positive association with urinary calcium calcium (P = .064). Insulin use did not have a significant relationship with urinary parameters but trended toward an inverse relationship with calcium (P = .051). pH was not a significant predictor of any urine constituent.Conclusion: In an ethnically diverse inner city patient population, patients with diabetes mellitus type 2 who use insulin have no significant differences in urine parameters when compared with those on oral hypoglycemics. Worsening glucose control as measured by HbA1c levels predicts increased urine citrate and volume. [ABSTRACT FROM AUTHOR]

Several studies have reported associations between vascular calcifications and urinary stone disease (USD). However, results have been inconsistent and the majority of studies did not report on race/ethnicity. We examined the association between vascular calcifications and USD in a large, racially/ethnically diverse patient population. We identified 672 USD cases and 672 controls (i.e., patients without a history of USD) from patients who underwent non-contrast CT imaging at Montefiore Medical Center in Bronx, New York between 2004 and 2013. Controls were matched to cases on age, sex and race/ethnicity. The non-contrast CT imaging was used to measure abdominal aortic calcification (AAC) and calculate the AAC severity score. Logistic regression models were used to examine associations of AAC presence and severity score with risks of USD and stone types. Cases and controls had similar AAC prevalence (45.2% vs. 44.8%, p = 0.87), and AAC severity score (median 10 vs. 9.3, p = 0.47). The presence of AAC (OR = 0.98, 95% CI 0.78–1.23; p = 0.86) or AAC severity score were not associated with risk of USD: ORs of 0.96, 0.87, 1.07 and 1.03 for increasing AAC quartiles (p-trend = 0.54). There were also no associations in the stratified analyses by race/ethnicity or by sex. However, when USD patients were stratified by stone type, brushite/apatite stone formers had an inverse association with the lowest quartile of AAC severity score (OR = 0.35, 95% CI 0.11–0.84, p = 0.04) in comparison to patients without AAC. Overall, we found no association between vascular calcifications and risk of urinary stone disease in this large, hospital-based, case–control study. [ABSTRACT FROM AUTHOR]

Introduction: We compared clinicopathologic characteristics and outcomes of radical nephrectomy (RN) for small renal masses (SRM) in patients with end-stage renal disease (ESRD) before or after transplant at a high-volume urologic and transplant center. Methods: We performed a retrospective review of patients with ESRD (glomerular filtration rate [GFR] <15 mL/min) who underwent RN for suspected malignant SRM from 2000-2018. Group 1 consisted of patients who underwent RN after transplant; group 2 underwent RN prior to transplant, and group 3 underwent RN without subsequent transplant. Dominant tumor size and histopathologic characteristics, recurrence, and survival outcomes were compared between groups. Chi-squared and Mann-Whitney U tests were used to compare categorical and continuous baseline and histopathologic characteristics, respectively. Univariate analysis and log rank test were used to compare RCC recurrence rates. Results: We identified 34 nephrectomies in group 1, 27 nephrectomies in group 2, and 70 nephrectomies in group 3. Median time from transplant to SRM radiologic diagnosis in group 1 was 87 months, and three months from diagnosis to nephrectomy for all groups. There were no statistically significant differences between pathologic dominant mass size, histologic subtype breakdown, grade, or stage between the groups. Rates of benign histology were similar between the groups. Univariate analysis did not reveal a statistically significant difference in recurrencefree survival between the groups (p=0.9). Conclusions: Patients undergoing nephrectomy before or after transplant for SRM have similar indolent clinicopathologic characteristics and low recurrence rates. Our results suggest that chronic immunosuppression does not adversely affect SRM biology. [ABSTRACT FROM AUTHOR]

To determine whether patients with ureteral stones received different standard of care in the emergency department (ED) according to various sociodemographic factors. We conducted a retrospective study of patients presenting to EDs in a large tertiary-care hospital in the Bronx, New York with a diagnosis of ureteral stones. Electronic chart review was used to assess each patient's ED course and to gather socio-demographic information. The primary outcomes of interest were administration of pain medication, prescription of alpha-1 antagonists to facilitate stone passage, and whether or not patients received CT scan or ultrasound. Associations of these outcomes with age categories, sex, race/ethnicity, BMI category, socioeconomic status and insurance status were examined using multivariate logistic regression models. 1200 patients were included in this analysis of which 616 (51%) were women. A large proportion of patients were minorities: 40% Hispanic, 15% non-Hispanic Black, and 20% other/multiracial. Patients aged 55–64 years and those 65 or older were less likely to receive pain medication compared to patients < 35 years (OR = 0.48, 95% CI 0.27–0.86, p = 0.01 and OR = 0.46, 95% CI 0.21–1.00, p = 0.05, respectively). Women were less likely than men to undergo any form of diagnostic imaging (OR = 0.52, 95% CI 0.35–0.76, p = 0.001). Similarly, patients in the lowest quintile of SES received less imaging than patients in the highest SES group (OR = 0.50, 95% CI 0.27–0.90, p = 0.02). Finally, women were less likely to receive alpha blockade compared to men (OR = 0.68, 95% CI 0.49–0.92, p = 0.014). Multiple disparities exist among patients presenting to the emergency department for ureteral stones. [ABSTRACT FROM AUTHOR]

To compare renal functional outcomes in patients with and without chronic kidney disease (CKD) to identify predictors of change in renal function after percutaneous nephrolithotomy (PCNL). We reviewed patients who underwent PCNL by a single surgeon over 3.5 years. Patients' pre- and post-operative Glomerular Filtration Rate (GFR) was calculated. Baseline GFR < 60 ml/min/1.73 m2 (stage ≥ 3 CKD) defined our CKD cohort. Patients' baseline renal function, comorbidities, stone parameters, and intra-operative variables were analyzed to determine the relationship with post-operative renal function after PCNL by multivariate analysis. 202 patients were analyzed. Mean follow-up time was 16 months. At baseline, 163 (80.7%) patients were free of CKD and 39 (19.3%) had CKD. Patients without CKD had an overall decrease in GFR from 105.6 to 103.3 ml/min/1.73 m2 (p = 0.494). 14/163 (8.6%) non-CKD patients experienced a significant decline in renal function after PCNL; 7/163 (4.3%) developed de novo CKD and 7 had a ≥ 30% decline in GFR. Patients with CKD had an overall increase in mean GFR post-operatively, from 47.3 to 54.0 ml/min/m2 (p = 0.067). Two in this cohort (5.1%) experienced a > 30% decline in renal function post-operatively. Age, gender, African American race, presence of comorbidities and pre-operative CKD were not significant predictors of renal function post-operatively on multivariate analysis. PCNL in this cohort appears GFR neutral in the setting of baseline CKD. CKD was not predictive of renal functional decline after PCNL. Given that stone disease carries a high recurrence rate and that CKD is associated with stone formers, further investigation into predictors of renal function change after PCNL is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Being able to predict glomerular filtration rate (GFR) plateau after partial nephrectomy (Pnx) is an important goal in providing patients with a confident projection of maintained renal function. As such, in an ethnically and socioeconomically diverse, inner city cohort of patients undergoing Pnx, we compared preoperative (pre-op) and day of discharge (DC) GFR to that of long-term GFR measured at 12–18 months to evaluate postoperative (post-op) GFR stability. Methods: A total of 162 patients who had undergone minimally invasive Pnx at a single institution between 2010 and 2016 were reviewed. Patients with the following available measurements were included: pre-op GFR, DC GFR, and long-term GFR (12–18 months after DC). Multivariate linear regression was performed to assess factors predictive of long-term GFR, including estimated blood loss, warm ischemic time, tumor size, length of stay, pre-op GFR, DC GFR, race, chronic kidney disease, diabetes mellitus, and hypertension. Results: Mean pre-op GFR, DC GFR, and long-term GFR were 70.754, 68.326, and 66.526 mL/(minute ·1.73 m2), respectively. Mean GFR change was −4.228 pre-op to long term and −1.800 DC to long term. No significant difference was observed between means of DC GFR and long-term GFR (p = 0.248) as well as between means of pre-op GFR and DC GFR (p = 0.062). A significant difference was observed between pre-op GFR and long-term DC GFR (p = 0.002). On multivariate analysis, both pre-op GFR (β = 0.532; 95% confidence interval [CI] = 0.256–0.808; p ≤ 0.001) and DC GFR (β = 0.312; 95% CI = 0.089–0.537; p = 0.007) were found to be strong predictors of long-term GFR (R2 = 0.608). Conclusions: Long-term GFR in a highly ethnically diverse inner city population recovering from Pnx is stable relative to GFR measured at DC from the hospital. Our findings demonstrate that patients experience a GFR plateau after surgery, resulting in minimal change in renal function at a mean of 14 months post-op. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: It is well known that adipose tissue plays a key role in the metabolic syndrome. We investigated whether visceral fat (VFA) and or subcutaneous fat (SQF) levels are associated with the tumor phenotype of small renal masses. Additionally, we sought to investigate the relationship between VFA and baseline renal function as measured by glomerular filtration rate. Materials and Methods: From 2002 through 2011, 144 patients undergoing minimally invasive partial nephrectomy were retrospectively reviewed by a radiologist for VFA and SQF fat measurements, using standard software. A third parameter, visceral adipose tissue percent (VAT%), was also calculated using the formula: (VAT%=[VFA/VFA+SQF]×100%). We used tertiles of VFA and SQF content to compare demographic and clinical characteristics. We also looked at VFA as a continuous variable. Associations between covariables were analyzed using multivariate logistic regression analysis and odds ratios with 95% confidence intervals. Results: Eighty-one patients had renal-cell carcinoma (RCC) and 30 patients had non-RCC pathology. On multivariate analysis, increasing BMI ( p=0.023), VFA ( p=0.048), VAT% ( p=0.028), and Charlson comorbidity score ( p=0.047) were significantly associated with worse preoperative Modification of Diet in Renal Disease (MDRD). In a subset multivariate analysis of the 81 patients with RCC, increasing VFA was statistically associated with worsening Fuhrman grade ( p=0.017). Conclusions: VFA may be linked to the pathophysiology of renal function in patients evaluated for renal masses. Additionally, VFA may be associated with worsening tumor grades in patients with small-volume RCC. Interestingly, SQF did not play such a role. This small study proposes an interesting physiologic link between VFA and the biology of both kidney function and tumor histology. Larger studies are needed to corroborate our findings. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies have proposed that nearby fat deposits may have metabolic influence on kidney cancer pathobiology. Both fat quantity and quality may play unique roles in this complex relationship. As such, we investigated whether perinephric fat surface area (PFA), a quantitative measure of fat, or Mayo Adhesive Probability (MAP) score, a qualitative measure, were predictive of malignant pathology or Fuhrman grade in small renal masses.Methods: A total of 317 patients undergoing minimally invasive partial nephrectomy between 2010 and 2016 for renal masses were retrospectively reviewed. Preoperative abdominal CT and MRI scans were measured for PFA and MAP scores. Multiple binary logistic regression models were created to identify predictive factors of malignant disease and Fuhrman grade.Results: A total of 253 patients had malignant masses, while 64 had benign masses. A total of 189 of the malignant masses were T1a, while 64 were designated T1b. A total of 221 patients with malignant masses had reported Fuhrman grades. Of these 211 patients, 143 (64.7%) had low-grade and 78 (35.3%) had high-grade disease. Mean PFA was 18.0 ± 13.3 cm2, while mean MAP score was 2.6 ± 1.2. Binary logistic regression analysis yielded three variables in the best-fit model for predictors of malignant pathology: MAP score (OR = 1.374, 95% CI: 1.007-1.873, P = 0.045), male sex (OR = 2.058, 95% CI: 1.004-4.218, P = 0.049), and BMI (OR = 1.064, 95% CI: 0.998-1.135, P = 0.059). Neither MAP nor PFA was predictive of Fuhrman grade.Conclusions: MAP score, a measure of perinephric fat quality, but not PFA, a qualitative measure of fat quantity, was predictive of malignant pathology, raising the question whether fat quality rather than quantity may be involved in the pathophysiology of RCC in a large and diverse patient population. Understanding the increasing burden of obesity, further studies are needed to elaborate on these findings and to discern the exact relationship between perinephric fat deposits and renal tumorigenesis. [ABSTRACT FROM AUTHOR]