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Purpose The urology work force is contracting at a time when service demand is increasing due to demographic changes, especially in rural areas. We investigated the impact of rural status and urologist density on kidney and renal pelvis, bladder and prostate cancer mortality at the county level in Illinois. Materials and Methods We stratified the 102 Illinois counties by 2003 RUCCs as urban (36, RUCCs 1 to 3) and rural (66, RUCCs 4 to 9). Area Health Resource Files were used for county demographic data and urologist density. County level age adjusted mortality rates from 1990 to 2010 were derived from National Center for Health Statistics data using SEER*Stat. We examined the associations of urological cancer mortality rates with rural status and urologist density. Results Average urologist density significantly differed between rural and urban counties (1.9 vs 3.4/100,000 population, p <0.01). The kidney and renal pelvis cancer mortality rate in rural counties was higher than in urban counties while that of prostate cancer was lower (4.9 vs 4.3 and 28.7 vs 32.2/100,000 population, respectively, each p <0.01). Urologist density correlated with the mortality rate of kidney and renal pelvis cancer (Pearson coefficient –0.33, p <0.01) but not with the bladder or prostate cancer mortality rate. Multiple regression analysis revealed that rurality and lower urologist density (p = 0.01 and <0.05) were significantly associated with higher kidney and renal pelvis cancer mortality. Conclusions Rural residence and low urologist density were associated with increased kidney and renal pelvis cancer mortality on the county level in Illinois. Further expansion and testing of evidence-based telemedicine is warranted because remote technical consultation is now technologically feasible, effective, inexpensive and satisfactory to patients. [ABSTRACT FROM AUTHOR]

Purpose: We compared the results of shock wave lithotripsy with a newer electromagnetic lithotripter to those of an electrohydraulic lithotripter using identical treatment and followup criteria. Materials and Methods: We performed a case matched comparison of 8,565 patients treated from 2003 to 2007 using the Medstone STS™ and the Modulith® SLX machines, matching for stone size, location and patient body mass index. The outcome of interest was treatment success in producing stone-free status. We report treatment characteristics, such as stone site and size, gating and final stone-free rate. Significance was considered at p <0.05. Results: Overall Modulith SLX and Medstone STS stone-free rates were equivalent (61.1% and 64.5%, respectively, p = 0.0664). Matching and logistic regression results showed that differences in the stone-free rate were insignificant for all stones (p >0.7592), lower pole kidney stones (p = 0.9659) and ureteral stones (p = 0.6409). Medstone STS performed better than Modulith SLX only for distal ureteral stones (83.63% vs 66.67%, p = 0.0154). The rate of post-lithotripsy secondary procedures was equivalent (p = 0.2079). The difference was insignificant for harder stones (p = 0.2988). Conclusions: Shock wave lithotripsy is equally effective using Medstone STS and Modulith SLX for different stone sizes and most stone sites. Shock wave lithotripsy is more successful for lower ureteral stones using the Medstone STS. To our knowledge this is the first study comparing these 2 commonly used lithotripters. [Copyright &y& Elsevier]

Purpose: Risk factors and treatment efficacy for ureteral obstruction following pediatric renal transplantation are poorly understood. We describe a single center experience with pediatric transplant recipients in an effort to discern risk factors and treatment efficacy. Materials and Methods: We retrospectively reviewed the pediatric renal transplant database at our institution from January 1984 to March 2008. Donor and recipient demographics, treatment indications, graft characteristics, surgical techniques, treatment course, complications and graft outcomes were abstracted from clinical records. Results: A total of 449 children (mean age 8.6 years) who underwent 526 renal transplants were included in the study. Ureteral obstruction requiring intervention developed in 42 cases (8%). Recipient age and gender, recipient and donor race, donor harvest technique, ureterovesical anastomosis with or without stenting, number of donor arteries, number of human leukocyte antigen mismatches, prior renal transplant and ischemia time were not significantly associated with increased incidence of ureteral obstruction. Renal failure secondary to posterior urethral valves was the only parameter significantly associated with increased incidence of ureteral obstruction (univariate OR 4.93, p = <0.0001; multivariate point estimate 7.59, p <0.0001). Of patients with ureteral obstruction 48% presented within 100 days after transplant. Kaplan-Meier analysis showed significantly decreased ureteral obstruction-free survival in patients with vs without posterior urethral valves (log rank test, p <0.0001). Ureteral obstruction, stenting and dilation were not significantly associated with increased graft loss or patient death. Conclusions: Ureteral obstruction after renal transplantation in children is a challenging complication that demands clinical vigilance. Posterior urethral valves appear to be a significant risk factor for post-transplant ureteral obstruction likely due to local factors such as ischemia, thick bladder wall and collagen remodeling. [Copyright &y& Elsevier]