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Nuclear renal scan is currently the gold standard imaging study to determine differential renal function. We propose helical computerized tomography as a more efficient way to gain renal function information. Renal parenchymal volume is measured and percent total renal volume is used as a surrogate marker for differential renal function.Computerized tomography and diuretic enhanced nuclear renal scan were performed in 33 patients with chronic obstruction. Computerized tomography was contrast enhanced in 23 cases and nonenhanced in 10. Diagnoses included ureteropelvic junction obstruction, ureteral stricture and extrinsic compression. Using semiautomated boundary delineation with manual editing method the parenchymal volume of each kidney was measured and percent renal volume was calculated. Percent renal volume was compared with percent renal function, as determined by nuclear renal scan. Correlations between the 2 measures were evaluated using the Spearman or Pearson coefficient.Strong correlations were observed between percent renal function and percent renal volume in all cases (r = 0.90, p0.001), including the enhanced (r = 0.87, p0.001) and nonenhanced (r = 0.95, p0.001) groups. Moderately strong correlations were noted in the less than 40% (r = 0.76, p0.001) and less than 30% (r = 0.64, p = 0.015) renal function subgroups.Differential renal volume measured from computerized tomography strongly correlates with differential renal function on nuclear renal scan for normal and chronically obstructed kidneys. Computerized tomography may serve as a single radiological diagnostic study for anatomical and functional assessment in patients in whom a poorly functioning kidney is suspected.

Genitourinary tract inflammation/ailments affect the quality of life and health of a large segment of society. In recent years, studies have demonstrated strong anti-oxidant effects of green tea and its associated polyphenols in inflammatory states. This in vitro study examined the antioxidant capabilities (and putative mechanisms of action) of green tea extract (GTE), polyphenon-60 (PP-60, 60 % pure polyphenols), (−)-epicatechin-3-gallate (ECG) and (−)-epigallocatechin-3-gallate (EGCG) in normal/malignant human bladder cells following catechin treatment ± 1 mM H2O2 (oxidative agent). Cell viability, apoptosis and reactive oxygen species (ROS) formation were evaluated. Our results showed that H2O2 exposure significantly reduced normal (UROtsa) and high-grade (TCCSUP, T24) bladder cancer (BlCa) cell viability compared with control-treated cells (p < 0.001). No affect on low-grade RT4 and SW780 BlCa cell viability was observed with exposure to H2O2. Compared to H2O2-treated UROtsa, treatment with PP-60, ECG and EGCG in the presence of H2O2 significantly improved UROtsa viability (p < 0.01), with strongest effects evoked by ECG. Additionally, though not as effective as in UROtsa cells, viability of both high-grade TCCSUP and T24 BlCa cells, in comparison to H2O2 -treated cells, were significantly improved (p < 0.01) by treatment with PP-60, ECG, and EGCG in the presence of H2O2. Overall, our findings demonstrate that urothelium cell death via H2O2-induced oxidative stress is mediated, in part, through superoxide (O2−·), and potentially, direct H2O2 mechanisms, suggesting that green tea polyphenols can protect against oxidative stress/damage and bladder cell death.

Botulinum toxins are well known for their ability to disrupt neurotransmission and cause muscle paralysis. Recently, urologists have discovered their beneficial effects in patients with neurogenic and overactive bladder conditions. This review is intended to provide a quick overview for urologists of the structure, function, and clinical uses of botulinum neurotoxin A in the lower urinary tract.

Recent studies have demonstrated a higher incidence of nephrolithiasis in the morbidly obese. Nephrolithiasis also has been described as a potential outcome after gastric bypass surgery. This is the first study to our knowledge that examines the incidence of nephrolithiasis in the morbidly obese in the setting of gastric bypass surgery at a tertiary referral center.We retrospectively reviewed the records of patients undergoing laparoscopic gastric Roux-en-Y bypass surgery for morbid obesity at our institution for the incidence of nephrolithiasis preoperatively, de novo stones postoperatively, and both preoperative and postoperative stone formation.Of the 972 patients who underwent a laparoscopic gastric bypass for the treatment of morbid obesity between 1990 and the present, 85 (8.8%) were found to have upper urinary-tract calculi preoperatively, and 32 (3.2%) had de novo stones postoperatively. Of those 85 who had stones preoperatively, 26 (31.4%) developed recurrent stones postoperatively.These results support findings in the current literature that nephrolithiasis has a higher incidence in the morbidly obese population. The combination of preoperative stone history and gastric bypass surgery may place patients at a higher risk of future stone formation. This latter group of patients should be screened for postoperative stone formation.

INTRODUCTION AND OBJECTIVES: Treatment for stress urinary incontinence using suburethral slings fails in 10–20% of surgeries. The underlying pathophysiology is not fully understood. In this study, we use translabial ultrasonography (US) to evaluate sling type, position, and morphology in patients after suburethral sling placement. We hypothesize that sling position and morphological changes have an impact on sling failure. METHODS: In this retrospective observational study, 51 consecutive patients were evaluated with translabial US for type, position, and morphology of suburethral slings between 2009 and 2010. Axial, coronal, and sagittal planes were obtained using a curvilinear 4-9mHz transducer. The patients were stratified, by cough test and bother scores, into patients with recurrent incontinence (n 33) and continent patients (n 18). Student’s t-test was performed for statistical evaluation comparing sling type, position, and morphology in both groups after suburethral sling procedures. RESULTS: By evaluating the sling type, translabial US revealed a similar number of patients in the incontinent and continent group treated with a transobturator (45% vs. 56%) or retropubic sling (55% vs. 44%), respectively. Comparing the position of suburethral slings in incontinent and continent patients with translabial US reveals that more patients in the incontinence group were found with slings located at the proximal urethra (48% vs. 16%, p 0.0123), less patients in the incontinence group were found with slings at the midurethra (39% vs. 67%, p 0.0323), and a similar number of patients in both groups were found with slings at the distal urethra (12% vs. 17%), respectively. Only incontinent patients presented with urethra or bladder perforation (6%). Morphologically, slings were significantly more folded in the incontinent group than in the continent population (73% vs. 6%, p 0.0016). CONCLUSIONS: In this study, we have shown that US can distinguish transobturator and retropubic slings and determine sling position. The type of sling does not seem to have an impact on recurrent UI, whereas the position, close to the bladder neck and/or folding of the sling, might be related to recurrent incontinence. Because it is the only diagnostic tool to determine the type of sling, locate the sling position, and follow up on its morphology, translabial US helps to elucidate the pathophysiology responsible for sling failure.

INTRODUCTION AND OBJECTIVES: Surgeons commonly use mesh for cystocele repair because the result is more durable than the classical anterior colporraphy. However, mesh repairs are associated with a number of complications. Therefore, we have developed a new technique named the CRISP procedure (Cystocele Repair using Interlocking Sutures of Polypropylene) and we are applying it to patients with central-lateral defects. The objective of this study is to review their functional outcomes. METHODS: All patients received preoperative evaluation with a history and physical examination, POP-Q exam, validated questionnaires (UDI-6, ISS, PFDI-20, PFIQ, and PISQ12), videourodynamics, cystoscopy, and dynamic pelvic MRI. All patients were evaluated postoperatively at 3, 6, 12 and 24 months. A brief description of the procedure is as follows: Indicated anti-incontinence and anti-prolapse procedures were performed concomitantly. A vertical incision is made from the bladder neck to the vaginal cuff and carried out laterally. 2–0 polypropylene sutures are used to incorporate the obturator and perivesical fascia bilaterally for lateral support. Four mattress sutures of 2–0 polypropylene are placed to repair the central defect. The lateral sutures are then interlocked with the central sutures. The lateral sutures are tied, followed by the central ones, thereby reducing the cystocele and creating a supporting net of sutures. The excess vaginal wall is excised in an asymmetric fashion with a rotational flap to cover the line of polypropylene sutures. Statistical analysis was performed using Student T-test using SPSS software and p 0.05 was considered significant. RESULTS: Between 1/2009 and 7/2010, the CRISP procedure was performed on 63 patients. Thus far, our only major complication is a patient who developed ureteric obstruction who was treated endoscopically. Tying the sutures prior to cystoscopy should prevent this complication. Postoperative validated questionnaires results showed improvement in quality of life due to urinary symptoms (improved from a mean of 3.6/6 to 2.0/6 (p 0.0022). PFDI-20 questions 1 to 6 (same as POPDI-6)indicate the level of bother caused by pelvic organ prolapse. The POPDI-6 score improved from 50 to 30.4 (p 0.0115). The vaginal bulge score from the PFDI-20 improved from 1.9/4 to 0.11/4 (p 0.002). CONCLUSIONS: The CRISP procedure is a promising alternative to cystocele repair with mesh. Preliminary data shows significant improvement in symptoms and quality of life, and this has been associated with minimal complications. Longer term data is needed to confirm our preliminary findings.

Cell culture and animal studies have demonstrated strong chemopreventative effects of green tea and its associated polyphenols in multiple cancers, though the exact mechanisms of action are not well understood. This in vitro study examined the antiproliferative/pro-apoptotic potential of green tea extract (GTE), polyphenon-60 (PP-60), (-)-epicatechin gallate (ECG) and (-)-epigallocatechin-3-gallate (EGCG) in both normal and malignant human bladder cells. Cell growth (proliferation/apoptosis) was measured in UROtsa (normal), SW780 (tumorigenic; low-grade), and TCCSUP (tumorigenic; high-grade) human bladder urothelial cells by cell proliferation (XTT) assay after treatment with 0-80 microg/mL of GTE, PP-60, ECG and EGCG for 72 h. Molecular signaling pathways of catechin-induced apoptosis were analyzed using Human signal transduction RT(2) Profiler PCR array (SuperArray). Compared to control-treated cells, treatment with catechin agents significantly suppressed cell growth in a dose-dependent fashion (P < 0.01), with strongest effects evoked by ECG and EGCG in UROtsa cells, ECG in low-grade RT4 and SW780 cells, and PP-60 and EGCG in high-grade TCCSUP and T24 cells. Microarray analysis indicated distinct differences in mRNA gene expression regarding growth signaling pathway activation induced by EGCG in normal/tumorigenic human bladder cell lines, providing a rationale for the putative therapeutic usage of green tea polyphenols against bladder disease.

Unilateral pulmonary edema of the dependent lung presented after laparoscopic living-donor nephrectomy in two patients. Treatment with O(2) supplementation and diuretics resulted in relief of symptoms and radiographic improvement. The presumed causes of this previously unreported complication of laparoscopic living donor nephrectomy include prolonged lateral decubitus positioning and high fluid requirements.

Pharmacotherapy is the first-line treatment for overactive bladder, but many patients discontinue drug therapy because of intolerable side effects, expense, or lack of longterm adherence. Alternative treatments are needed for patients who are unable to tolerate pharmacotherapy or who do not derive the desired benefits. Sacral nerve stimulation therapy has evolved into one of the most widely accepted treatment modalities in the arena of neurourology. Sacral nerve stimulation activates or "resets" the somatic afferent inputs that play a pivotal role in the modulation of sensory processing for micturition reflex pathways in the spinal cord. This minimally invasive technology offers a safe, reliable, and durable treatment for lower urinary tract dysfunction.

While performing laparoscopic nephroureterectomy, different techniques are used for removal of the distal ureter and bladder cuff. We present a series of patients with urothelial carcinoma of the renal pelvis or ureter who underwent hand-assisted laparoscopic nephroureterectomy (HALNU) with open cystotomy for removal of the distal ureter and bladder cuff.From January 2000 to August 2004, 34 patients underwent HALNU. The hand-port device was placed in a lower-midline infraumbilical incision in all cases. After laparoscopic removal of the kidney and ureter down to the bladder, the hand port incision was extended caudally to allow open cystotomy. Intravesical dissection was performed at the ureteral orifice, and the bladder cuff and distal ureter were removed in a traditional open fashion.The mean operative time was 317 +/- 150 (SD) minutes, but the median operative time was 247 minutes. The mean estimated blood loss was 252 +/- 146 mL. The mean length of stay was 7.6 +/- 6.0 days, but the median stay was 5 days postoperatively (range 3-25). The mean morphine equivalent required postoperatively was 33 +/- 22 mg. The time of Foley catheter removal ranged from 3 to 15 days (mean 6.1 +/- 3.8 days), with no cases of extravasation by cystography at removal. Within a mean follow-up of 13.9 months, no recurrence of urothelial carcinoma was seen at the site of the excised ureteral orifice.A HALNU utilizing an open cystotomy for removal of the entire distal ureter with a bladder cuff provides excellent oncologic control while not adding significantly to the operative time or the morbidity of the procedure.