Search

Purpose The COVID-19 pandemic is an unprecedented global event that has caused significant fear and anxiety across all populations. To date, there have been no studies on how major health crises have affected the stone-related quality-of-life (QOL) of urolithiasis patients. In this multi-institutional study, we investigated whether the fear of COVID-19 affects the QOL of urolithiasis patients during the COVID-19 pandemic using the Fear of COVID-19 Scale (FCV-19S) and the Wisconsin Stone Quality of Life (WISQOL) questionnaires. Materials and Methods Patient-reported data collection occurred between April-October 2020 during the COVID-19 pandemic where many procedures (radiological or surgical) and visits were either delayed or cancelled. The scores generated from patient-reported responses to questionnaires were correlated and then further sub-analyzed dependent on categorical responses related to procedural delays or care and were analyzed via the Student's T-test. A single factor analysis of variance (ANOVA) was performed to analyze varying QOL scores across the FCV-19S quartiles. Results 400 respondents participated in this study. Overall mean total standardized FCV-19S and WISQOL scores (both transformed to min-max 0-100) were 34.3 and 70.3 respectively. A significant inverse correlation (r=-0.265, p

To evaluate the impact of chronic stone recurrence on an individual's quality of life using the validated Wisconsin Stone Quality of Life (WISQOL) questionnaire. We collected cross-sectional data on patients with kidney stones from 14 institutions in North America. A stone event was defined as renal colic, stone-related procedure or emergency department visit. The regression analyses using general linear models and pairwise comparison determined the impact of the number of stone events on quality of life. The median number of stone events among the 2205 patients who completed the questionnaire was 3 (IQR 1-6). The mean total score was 107.4 ± 28.7 (max 140 points). The number of lifetime stone events was an independent predictor of lower quality of life (p 0.001), specifically, score declined significantly beyond five events. Compared with patients who experienced a single stone event, there was a 0.4, 2.5, and 6.9 point decline in the adjusted mean WISQOL score after 2-5, 6-10, or 10 events, respectively. The cumulative number of lifetime stone events was associated with a lower quality of life when more than five stone events were occurred. These findings underscore the importance of efforts to determine the underlying metabolic etiology of urolithiasis in the recurrent stone former, and the institution of a regimen to place their stone disease in remission.

OBJECTIVE To build the Wisconsin Stone Quality of Life Machine-Learning Algorithm (WISQOL-MLA) to predict urolithiasis patients' health-related quality of life (HRQoL) based on demographic, symptomatic and clinical data collected for the validation of the Wisconsin Stone Quality-of-Life (WISQOL) questionnaire, an HRQoL measurement tool designed specifically for patients with kidney stones. MATERIAL AND METHODS We used data from 3206 stone patients from 16 centres. We used gradient-boosting and deep-learning models to predict HRQoL scores. We also stratified HRQoL scores by quintile. The dataset was split using a standard 70%/10%/20% training/validation/testing ratio. Regression performance was evaluated using Pearson's correlation. Classification was evaluated with an area under the receiver-operating characteristic curve (AUROC). RESULTS Gradient boosting obtained a test correlation of 0.62. Deep learning obtained a correlation of 0.59. Multivariate regression achieved a correlation of 0.44. Quintile stratification of all patients in the WISQOL dataset obtained an average test AUROC of 0.70 for the five classes. The model performed best in identifying the lowest (0.79) and highest quintiles (0.83) of HRQoL. Feature importance analysis showed that the model weighs in clinically relevant factors to estimate HRQoL, such as symptomatic status, body mass index and age. CONCLUSIONS Harnessing the power of the WISQOL questionnaire, our initial results indicate that the WISQOL-MLA can adequately predict a stone patient's HRQoL from readily available clinical information. The algorithm adequately relies on relevant clinical factors to make its HRQoL predictions. Future improvements to the model are needed for direct clinical applications.

Background: Ureteral stricture disease is a troubling urologic issue that can be managed with surgical reconstruction or, more conservatively, with chronic nephrostomy tubes or ureteral stents. These indwelling tubes require exchanges and are prone to complications such as encrustation or stent failure. Metallic ureteral stents are designed to be more resistant to extrinsic compression and allow for exchanges at longer intervals. However, encrustation or tissue ingrowth can occur with these stents as well. The removal of encrusted or embedded metallic ureteral stents poses a difficult clinical scenario. We present a case of an encrusted metallic stent embedded in a proximal ureteral stricture requiring percutaneous endoscopic removal with a novel looped-wire technique. Case Presentation: A 50-year-old Caucasian man with bilateral ureteral stricture disease, managed with chronic indwelling metallic stents, failed retrograde removal on the right during routine exchange. Staged procedures with percutaneous nephrostomy, followed by combined percutaneous antegrade and retrograde endoscopy were required to observe and access the embedded stent. The exposed metallic surface was unable to be grasped by available instruments through flexible endoscopy. Under endoscopic control with fluoroscopic guidance, a polytetrafluoroethylene (PTFE)-coated guidewire was looped around the metallic stent. With gentle traction on the wire loop, the embedded stent curl was delivered out of the stricture and into the renal pelvis from where it was extracted carefully with graspers inserted through a rigid nephroscope. Follow-up antegrade fluoroscopic studies with contrast showed no extravasation. Conclusion: Percutaneous removal of metallic stents retained within the ureter has unique challenges. We present a novel method of extraction of a retained metallic stent with a looped PTFE-coated guidewire, which may safely and effectively be used in complex situations.

Purpose: Metabolic syndrome (MetS) is a cluster of metabolic diseases that is linked to atherosclerotic cardiovascular disease. MetS has also been linked to increased nephrolithiasis. However, limi...

Purpose:Ureteral access sheaths are commonly used during ureteroscopy to facilitate stone removal, improve visibility and maintain low intrarenal pressures. However, the use of a ureteral access sh...

Ureteral fibroepithelial polyps (UFP) are relatively rare, benign tumors. A total of 236 total cases were documented between 1932 and 2013. Notably, imaging studies, including computerized tomography (CT) and magnetic resonance imaging (MRI) are often negative. This report details a case of a patient with a UFP who presented with hematuria. CT suggested a possible 1.8 cm mass, but subsequent MRI was negative. Cystoscopy showed a polyp that prolapsed out of the left ureter and into the bladder with peristalsis. The patient subsequently underwent retrograde ureteroscopy and holmium laser excision of the polyp.

INTRODUCTION AND OBJECTIVE:Existing animal models of renal oxalate excretion utilize either gut or peritoneal cavity for oxalate absorption. Ex vivo renal perfusion is an established tool for graft...

INTRODUCTION AND OBJECTIVE:24-hour urinary oxalate testing is a key component of comprehensive metabolic evaluation, yet it cannot measure transient spikes in oxalate concentration such as followin...

In vitro experiments demonstrate calcium oxalate (CaOx) supersaturation (SS) drives CaOx nucleation and growth. We investigated the link between 24-hour urine SS CaOx and in vivo stone growth through a natural history, imaging study.Using an institutional review board-approved database, we sought80% CaOx stone formers who prior to stone intervention obtained 2 separate computerized tomography (CT) scans with at least one 24-hour urine collection between scans. Two blinded reviewers calculated bilateral 3-dimensional stone volume using the Visage 7® region of interest pen tool. CT volume difference was divided by time between scans, and SS CaOx was grouped into low (5), medium (5-10) and high risk (10). Statistical significance between groups was assessed by Kruskal-Wallis test.We identified 80 individuals with stone growth measured by 3-dimensional CT (mean ∼7 months between studies). Inter-reviewer reliability of CT volume measurement was well correlated (0.98, Gwet's AC2), and an arbitrator was only needed in 13/160 (8%) cases. Median stone volume growth/year was 15%, 71% and 177% for low, medium and high risk groups, respectively (p0.001). Despite inter-individual variation, best fit of mean SS CaOx vs stone volume growth was moderately correlated (Spearman's rho=0.53, p0.001).In a population of pure CaOx stone formers, increased 24-hour SS CaOx risk was associated with increased in vivo stone growth. Further investigations using CT volumetric stone growth may allow for the noninvasive study of stone growth modulators, improved stone risk prediction and development of a kidney stone simulator.

Background: Intravenous administration of iodinated contrast agents carries the risk of allergic reaction, yet this risk is unclear with administration into the urinary tract. We sought to evaluate...

OBJECTIVE To determine if medical therapy affects long-term clinical outcomes in uric acid stone formers (UASF). METHODS We identified 53 UASF who had complete stone clearance following stone procedure by computed tomography (CT) and had ≥1 postoperative 24-hour urine collection and a clinical follow-up ≥6 months with a surveillance CT scan. Patients were divided into "adherent to medical therapy" (compliance with potassium citrate ± allopurinol verified by computerized pharmacy data) or nonadherent groups. Primary outcomes were CT stone recurrence rate and need for surgical stone intervention. RESULTS We found 28 of 53 (53%) adherent and 25 of 53 (47%) nonadherent individuals (14 declined medication, 11 intolerant). With median follow-up of 24 months, no significant differences were noted between groups in regards to stone recurrence (32%; P = .99) or in 24-hour urine pH compared to baseline or follow-up (range 5.46-5.62; P = 0.06). Adherent patients, however, had smaller CT stone recurrence sizes (6.3 ± 3.8 vs 11.8 ± 6.2 mm, P = .02), were 28% less likely to require stone surgery compared to those without therapy (P

Kidney stones are a source of significant morbidity which have been shown to negatively impact health related quality of life. We sought to understand the association between health related quality of life, socioeconomic status and race among patients with kidney stones.Patients with stones at a total of 11 stone centers across the United States completed the WISQOL (Wisconsin Stone Quality of Life questionnaire). The patient ZIP Code™ was used to estimate household income. A mixed effects regression model was constructed for analysis with ZIP Code as the random intercept.A total of 2,057 stone formers completed the WISQOL. Lower income was independently associated with significantly lower health related quality of life (β = 0.372, p = 0.014), as were nonwhite race (β = -0.299, p = 0.001), unemployed work status (β = -0.291, p = 0.008), female gender (β = -0.204, p0.001), body mass index greater than 40 kg/mLower income, nonwhite race and unemployed work status were independently associated with lower health related quality of life among patients with kidney stones. While clinical characteristics such as body mass and stone disease severity were also associated with health related quality of life, this study shows that socioeconomic factors are similarly important. Further research to understand the specific mechanisms by which socioeconomic status and race impact health may lend insight into methods to optimize clinical treatment of stone formers and patients with other chronic diseases.

We aim to describe factors that are associated with kidney stones 20 mm or larger. This information would potentially guide research regarding factors of kidney stone growth. We retrospectively reviewed a patient cohort who underwent surgical treatment for kidney stones. Patients with detailed demographics, 24-h urine testing, and kidney stone profiling were included. Large stone was defined as measuring 20 mm or more. Univariate analysis was conducted to assess variables associated with kidney stones larger than 20 mm. Multivariate logistic regression and statistical machine learning methods were used to infer prediction models. The specific composition of kidney stones, laboratory testing results, and detailed demographics of 277 patients were included in our analysis. Multiple variables were significantly associated with large stones in univariate analysis. The final model that predicts large stone size includes several variables from different domains: hypertension (OR = 1.91; 95% CI 1.06, 3.43), older age (60+ vs 20–40) (OR = 2.46; 95% CI 1.07, 5.63), decreased calcium oxalate supersaturation (OR = 0.92; 95% CI 0.85, 0.99), and higher percentage of protein in stone composition (OR = 5.64; 95% CI 2.04, 15.58). This model yields a sensitivity 83% and specificity of 56%. Models using machine learning algorithms identified similar predictors, but the performance varies. Our model yielded good performance, and it could potentially be used as a clinical tool for predicting large stones and identifying factors affecting kidney stone growth. Similar analysis in other cohorts should be pursued to externally validate findings.

Objective To survey the characteristics, career goals, and practice preferences of current urology applicants. Methods An anonymous survey was emailed to applicants pursuing a residency position at the University of Florida for the 2017-2018 academic year Urology Match. The survey included questions on demographics, motivating factors to pursue urology, plans for fellowship training, and anticipated and desired practice patterns. Results A total of 151 of 295 applicants completed the survey, mean age 26.9± SD 2.3. Males had a higher interest in academics/research, cancer, men's health, and minimally invasive surgery technology. Females had a higher interest in public health, surgery, and mixture of surgical and medical management. A total of 64.1% planned on completing a fellowship. Males had a higher interest in urologic oncology and endourology. Females had a higher interest in female pelvic medicine and reconstructive surgery, andrology and sexual medicine, and pediatric urology. A total of 76.9% anticipated having an academic affiliation, 68.9% working in an urban setting, and 98% working full-time, with no difference based on gender. For desired quality of life after residency, maximum number of hours considered acceptable was 51-60 (36.4%) and 61-70 (35.1%). Regarding an acceptable call schedule, most considered 2-4 nights per month reasonable. Most felt an acceptable starting salary was $250,000-$400,000 and $200,001-$350,000 for private practice and academic urology, respectively. Conclusion Current urology applicants desire to work in academics, urban settings, and pursue subspecialty fellowship training. What they consider acceptable work hours, call schedule, and financial compensation appear compatible with the current practice of urology.

To our knowledge it is unknown whether the benefits of medical management of urolithiasis outweigh the potential side effects of the medications used, including potassium citrate and thiazide diuretics. Therefore, we evaluated the relationship between potassium citrate or thiazides and overall stone related health related quality of life.Cross-sectional data were obtained on stone forming enrollees in the North American Stone Quality of Life Consortium. We used the WISQOL (Wisconsin Stone Quality of Life) questionnaire to compare health related quality of life between patients treated and not treated with potassium citrate or thiazide type diuretics. Additionally, the likelihood of gastrointestinal complaints was compared between those prescribed and not prescribed potassium citrate. The likelihood of fatigue and sexual complaints was also compared in those prescribed and not prescribed thiazides.Of the 1,511 subjects, including 787 males and 724 females, 279 were on potassium citrate and 238 were on thiazides at study enrollment. Patients prescribed potassium citrate had higher health related quality of life in each domain vs those not prescribed potassium citrate (p0.001). Patients prescribed thiazides had higher health related quality of life in each domain compared to those not prescribed thiazide (all p0.01). Those prescribed potassium citrate were less likely than those not prescribed potassium citrate to report nausea, stomach upset or cramps (OR 0.57, p0.001). Patients prescribed thiazides were less likely than those not prescribed thiazides to report fatigue (OR 0.63, p = 0.004) or reduced sexual interest and/or activity (OR 0.64, p = 0.005).Among stone formers the use of potassium citrate and thiazides was associated with better health related quality of life across all WISQOL domains without an increased likelihood of gastrointestinal complaints and fatigue or sexual complaints, respectively. These findings may be useful when counseling patients regarding the initiation of potassium citrate or thiazides for medical management of nephrolithiasis.

This chapter reviews a pivotal trial on the role of increased water intake for secondary prevention of recurrent stone formation patients with idiopathic calcium nephrolithiasis. Patients randomized to the intervention arm were instructed to titrate their water intake to a daily urine output of at least 2 liters; patients in the control arms were not given any specific instructions. Increased water intake resulted in fewer stone recurrences, longer time to recurrence, and reduced calcium oxalate and calcium phosphate supersaturation.

This chapter summarizes the results of the SUSPEND trial, a methodologically rigorous three-armed randomized controlled trial of medical expulsive therapy in the form of the alpha-blocker tamsulosin or the calcium channel blocker nifedipine versus placebo. The mean stone size in all three groups was comparable and three-quarters of the stones were 5 mm or less. It was a “negative trial” that failed to demonstrate a substantial benefit from the widely established practice of treating patients with small ureteral stones with medical expulsive therapy. Serious adverse events were very infrequent.

This chapter reviews the findings of the initial case series of patients with renal stones treated with extracorporeal shock wave lithotripsy (ESWL) with 12 months of follow-up. In the majority of patients, the renal stones were broken up into fragments that could pass spontaneously, and only a few patients required surgical interventions. Renal function did not appear adversely impacted by the procedure.

This chapter reviews the findings of an important randomized controlled trial of ureteroscopy versus shock wave lithotripsy in adult patients with isolated lower pole stones 1 cm or less in size in whom treatment was indicated. The type of ureteroscope and shock wave lithotripter, the power settings used, and the number of shocks administered were left to the discretion of the treating physician. The study suggested that there is little to no difference in stone-free rates between the two modalities for the treatment of small lower pole renal calculi.

This chapter reviews the results of an important observational study seeking to establish how, in individuals without a history of nephrolithiasis, dietary calcium intake is associated with the risk of symptomatic stone disease. The study found that the mean daily dietary calcium intake was lower in the group who formed stones compared to those who did not and that, after adjusting for covariates, high daily dietary calcium intake was strongly associated with decreased risk of stones.

This chapter summarizes the results of the Lower Pole Study I study in which patients with symptomatic lower pole renal calculi were randomized to receive extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL). The study found that patients receiving ESWL had lower stone-clearance rates and a more frequent need for retreatment but lower morbidity, whereas those receiving PCNL had higher stone-clearance rate and fewer retreatments but greater morbidity.

Background: Periureteral venous rings are a rare congenital anomaly involving the inferior vena cava (IVC) and the right ureter, where the ureter courses through a venous ring made by the duplication of the IVC during embryogenesis. This anatomic anomaly is also referred to as a transcaval ureter. Although most patients are asymptomatic and radiographic findings are incidental, some patients can be symptomatic. We present the first reported case of asymptomatic obstructive ureterolithiasis at the level of a periureteral venous ring that was effectively treated with endoscopic management. Case Presentation: A 47-year-old woman was found to have right hydroureteronephrosis on MRI. Further CT imaging showed an obstructing ureteral stone at the level of a periureteral venous ring. After initial decompression with ureteral stenting, she underwent ureteroscopy that revealed the ureteral stone at the level of the venous anomaly. The stone was fragmented and removed with laser lithotripsy and stone basket manipulation. After a period of ureteral stenting and removal, she had improved hydroureteronephrosis, no symptoms of ureteral obstruction, and stable renal function. Given these findings, she elected for surveillance with imaging in lieu of any reconstructive procedure to transpose the ureter around the venous anomaly. Conclusions: We present the first reported case of obstructive ureterolithiasis at the level of a periureteral venous ring. Our experience suggests that, with preoperative ureteral stenting, obstructing ureteral stones in the setting of an IVC anomaly can be managed with retrograde flexible ureteroscopy. Conservative laser settings and minimal torqueing of the ureteroscope are advised given adjacent vascular anomaly. Cases wherein the affected ureteral segment is too constricted or tortuous to allow for stone passage or for ureteroscopy may require management by percutaneous antegrade intervention. Surgical reconstruction of the ureter should also be considered.

Objectives: To compare direct ureteral length measurements with predictive formulas used for the preoperative assessment of ureteral length, and to evaluate patient factors that impact the accuracy...

INTRODUCTION AND OBJECTIVE:Urolithiasis is associated with a decreased health-related quality of life. The Wisconsin Stone Quality of Life (WISQOL) questionnaire is a validated instrument to evalua...

Introduction: Urolithiasis causes a significant impact on health-related quality of life (HRQOL). Patients with kidney stones have high levels of stress and anxiety. Symptom resolution often requires treatment. Travel distance is a barrier to care but little is known about its effects on HRQOL. We hypothesize that increased distance to treatment site is associated with decreased HRQOL. Methods: Patients with a history of stones were enrolled at 11 tertiary centers as part of the QOL Stone Consortium of North America. HRQOL data were obtained using the Wisconsin Stone Quality of Life questionnaire (WISQOL). We calculated distance between patient and treatment site using national ZIP codes. We used linear models to evaluate the effect of distance on HRQOL, while also considering demographics data, stones/symptom status, and distance. Results: Of the 1676 enrolled patients, 52% were male, 86% non-Latino White, and the mean age was 53 years. Mean distance to treatment site was 63.3 km (range: 0–3774), with 74% reporting current stones and 45% current symptoms. WISQOL score and distance were negatively correlated for patients reporting current stones and symptoms (p=0.0010). Linear modelling revealed decreased WISQOL scores for patients with symptoms as distance increased from treatment site (p=0.0001), with a 4.7-point decrease for every 100 km traveled. Conclusions: Stone disease imposes significant burden on patients’ HRQOL due to a variety of factors. Patients with active stone symptoms report worse HRQOL with increased distance to their treatment site. Possible etiologies include travel burden, increased disease burden, decreased healthcare use, and delays in care.

Objective To better understand today's urology applicant. Methods All 2016 Urology Residency Match applicants to the study-participating institutions were provided a survey via email inquiring about their paths to urology, their career aspirations, how they evaluate a training program, and how they perceive residency programs evaluate them. Results Of a possible 468 applicants registered for the match, 346 applicants completed the survey. Only 8.7% had a mandatory urology rotation, yet 58.4% believed that a mandatory urology rotation would influence their career decision. Most applicants (62.1%) spent more than 8 weeks on urology rotations, and 79.2% completed 2 or more away rotations. Applicants were attracted to urology by the diversity of procedures, prior exposure to the field, and the mix of medicine and surgery, with mean importance scores of 4.70, 4.52, and 4.45 of 5, respectively. Female applicants were more likely to be interested in pediatric urology, trauma or reconstructive urology, and female pelvic medicine and reconstructive surgery. Significant differences in survey results were noted when applicants were separated by gender. Three-fourths of respondents (75.7%) applied to more than 50 residency programs. Applicants ranked operative experience, interactions with current residents, and relationships between faculty and residents as the most important criteria when evaluating training programs. Of the subspecialties, 62.1% of applicants expressed most interest in urologic oncology. At this stage in their career, a significant majority (83.5%) expressed interest in becoming academic faculty. Conclusion This study provides new information that facilitates a more comprehensive understanding of today's urology applicants.

Aspirin is often stopped prior to percutaneous nephrolithotomy due to concern about the surgical bleeding risk. There is evidence that discontinuing aspirin perioperatively increases thromboembolic events and continuing it may be safe. We assessed the effect of continuing low dose aspirin through percutaneous nephrolithotomy and its effect on surgical and safety outcomes.We retrospectively reviewed the records of 285 consecutive percutaneous nephrolithotomies performed between 2012 and 2015 at our institution. We compared outcomes and complications in patients who continued 81 mg aspirin daily to those in patients not receiving aspirin.A total of 67 patients (24.5%) were maintained on low dose aspirin and 207 (75.5%) were not on aspirin. The aspirin group was older (66 vs 52 years), included more tobacco users (58.2% vs 31.4%) and had a higher ASA® (American Society of Anesthesiologists®) score (2.9 vs 2.5, all p0.001). There was no difference in mean S.T.O.N.E. (size, topography [stone location], obstruction, number of stones and evaluation of HU) score (7.6 vs 7.7, p = 0.71) or blood loss (44 vs 54 ml, p = 0.151). There was no difference in residual stone fragment size, including 0 to 2 mm in 65.3% vs 61.4% of aspirin vs no aspirin cases, 3 to 4 mm in 19.4% vs 16.2% and greater than 4 mm in 15.3% vs 22.4% (p = 0.407). Length of stay and the change in hemoglobin, hematocrit and creatinine were similar. There was no difference in the readmission rate (14.9% vs 12.6%, p = 0.618) or the total complication rate (34.4% vs 26.6%, p = 0.221). There was also no difference in the number of major complications (10.4% vs 5.8%, p = 0.193), bleeding complications (3.0% vs 2.9%, p = 0.971) and the transfusion rate (1.5% vs 1.0%, p = 0.57).Percutaneous nephrolithotomy appears effective and safe in patients who continue low dose aspirin perioperatively.

Background Iron deficiency anemia is a common finding in women of child-bearing age. Pica, or the ingestion of non-food or non-nutritive items, is a well-known manifestation of iron deficiency. A high sodium diet increases risk for nephrolithiasis. We describe the case of a 31-year-old woman with recurrent calcium nephrolithiasis and anemia who ate ice chips as well as spoons of salt daily. Treatment of pica may prove effective in preventing recurrent nephrolithiasis. Case presentation A 31-year-old white woman with a past medical history of menorrhagia, anemia, and recurrent calcium nephrolithiasis presented for preoperative evaluation prior to ureterolithotomy. She described a daily pattern of eating continually from a cup of ice chips accompanied by multiple spoons of salt directly out of a salt shaker. These cravings had been present for many years, were bothersome to her, and interfered with her daily life. Laboratory findings revealed hemoglobin of 10.9 g/dL with ferritin of 3 ng/mL. History, physical, and laboratory data were consistent with pica secondary to iron deficiency anemia. She was prescribed orally administered ferrous sulfate 325 mg three times a day with meals. She continues to struggle with the symptoms of pica and orally administered supplementation. Conclusions It is important that clinicians consider the possible diagnosis of sodium chloride pica in patients with iron deficiency anemia and recurrent nephrolithiasis. Treatment of anemia and resolution of pica may prove effective in preventing future nephrolithiasis. Specific questioning about pica symptoms in patients with iron deficiency anemia and recurrent nephrolithiasis may be helpful diagnostically and therapeutically.

Kidney stone formers have lower health related quality of life than nonstone formers. The North American Stone Quality of Life Consortium is a multicenter, longitudinal, prospective study of health related quality of life in patients with kidney stones using the WISQOL (Wisconsin Stone Quality of Life Questionnaire) with data on 2,052 patients from a total of 11 centers. This study is a subanalysis of cross-sectional data looking at the association of age, gender and race on health related quality of life of stone formers.We performed multivariable analyses of ordinal logistic regression analyses to determine the impact of age, gender and race on health related quality of life, adjusting for other baseline covariates. The proportional odds assumption of ordinal logistic regression was checked. Total score and scores on 4 subdomains (social functioning, emotional functioning, stone related impact and vitality) were included.Median total score for all patients was 80.4. On multivariable analysis older patients had a significantly higher total health related quality of life score than younger patients (per 10-year increase OR 1.25, p0.0001). Male patients had higher scores than females (OR 1.56, p = 0.0003) and nonCaucasian patients had lower health related quality of life than nonLatino Caucasian patients (OR 0.63, p = 0.0045).Younger and female patients with kidney stones have lower health related quality of life than older and male patients, respectively. NonCaucasian patients with stones also have lower health related quality of life. The clinical impact of these findings might include future implications for patient counseling, including dietary and medical management of stone disease, and potential changes to the paradigm of the surgical management of stones.

INTRODUCTION AND OBJECTIVES:In vitro studies have shown that calcium oxalate supersaturation (CaOX SS) principally drives CaOX stone formation and growth. As this has not been previously validated ...

Proper fluoroscopic education and protocols may reduce the patient radiation dose but few prospective studies in urology have been performed. Using optically stimulated luminescent dosimeters we tested whether fluoroscopy time and/or entrance skin dose would decrease after educational and radiation reduction protocols.At default manufacturer settings fluoroscopy time and entrance skin dose were prospectively measured using optically stimulated luminescent dosimeters in patients undergoing ureteroscopy, retrograde pyelogram/stent or percutaneous nephrolithotomy with access for stone disease. A validated radiation safety competency test was administered to urology faculty and residents before and after web based, hands-on fluoroscopy training. Default fluoroscopy settings were changed from continuous to intermittent pulse rate and from standard to half-dose output. Fluoroscopy time and entrance skin dose were then measured again.The cohorts of 44 pre-protocol and 50 post-protocol patients with stones were similarly matched. The change in mean fluoroscopy time and entrance skin dose from pre-protocol to post-protocol was -0.6 minutes and -11.6 mGy (33%) for percutaneous nephrolithotomy (p = 0.62 and0.001), 0.5 minutes and -0.1 mGy (34%) for ureteroscopy (p = 0.42 and 0.31), and 0.1 minute and -0.1 mGy (29%) for retrograde pyelogram/stent (p = 0.85 and 0.49, respectively). Urologist post-training test scores increased 30% from pretraining scores (p = 0.1).Radiation safety training protocols improved clinical knowledge but did not significantly alter fluoroscopy time. Changing equipment default settings to intermittent pulse rate (12 frames per second) and half-dose lowered the entrance skin dose by 30% across all endourology patients but most significantly during percutaneous nephrolithotomy. To limit patient radiation exposure fluoroscopy default settings should be decreased before all endourology procedures and image equipment manufacturers should consider lowering standard default renal settings.

Background: A number of occupations and professions may be associated with unique hazards relevant to urologic care. Case Presentation: We relate the presentation, care, and the occupational hazard of urinary tract infection (UTI), presenting as cystitis and pyelonephritis, with stone formation in a scuba diver. The patient voiced concern that his diving suit malfunction was related to his UTI and stone disease. We review the risk of UTI in the diving environment. We also report the development of infection-related stone in this case. Our evaluation included consultation with an expert in diving and associated equipment. Conclusion: Careful installation of P-valves in dry suits, proper maintenance, and monitoring for leakage improved post-dive hygiene, and proper maintenance of P-valve tubing and diving equipment may decrease the incidence of these complications described. Urologists treating UTI and stone disease should be aware of this occupation-related hazard.

INTRODUCTION AND OBJECTIVE:The Wisconsin Stone Quality of Life (WISQOL) questionnaire, a quality of life (QOL) measurement tool designed specifically for kidney stone patients was recently validate...

Bladder calculi are rare in children; they are typically associated with congenital abnormalities of the bladder, foreign bodies, intestinal mucosa, or infection. There is a high risk of bladder calculi with bladder exstrophy, a rare congenital condition. Primary bladder closure is usually performed in the first days of life, but subsequent bladder calculi are associated with about 15% of bladder exstrophy repairs. We report a case of hair-bearing epithelium serving as a nidus for intravesical stone formation in a 24-year-old male who underwent exstrophy repair as an infant. Our case emphasizes need for close and continued follow-up in patients who receive bladder exstrophy repair as infants. This is the first report in the literature of hair-bearing epithelium serving as the nidus for bladder stones in this unique patient population.

Despite guidelines, routine 24-hour urine testing is completed in10% of high-risk, recurrent stone formers. Using surrogates for metabolic testing, such as key patient characteristics, could obviate the cost and burden of this test while providing information needed for proper stone prevention counseling.We performed a retrospective study of 392 consecutive patients from 2007 to 2014 with ≥2 lifetime stone episodes,70% calcium oxalate by mineral analysis, and ≥1 24-hour urine collection. We compared mean 24-hour urine values by age in decades. We used logistic regression and receiver operating characteristic (ROC) curve analysis to assess the predictive ability of age, gender, body mass index (BMI), and comorbidities to detect abnormal 24-hour urine parameters.The mean age of the cohort was 51 ± 16 years. Older age was associated with greater urinary oxalate (p-trend0.001), lower urinary uric acid (UA) (p-trend = 0.007), and lower urinary pH (p-trend0.001). A nonlinear association was noted between age and urinary calcium or citrate (calcium peaked at 40-49 years, p = 0.03; citrate nadired at 18-29 years, p = 0.001). ROC analysis of age, gender, and BMI to predict 24-hour urine abnormalities performed the best for hyperuricosuria (area under the curve [AUC] 0.816), hyperoxaluria (AUC 0.737), and hypocitraturia (AUC 0.740). Including diabetes mellitus or hypertension did not improve AUC significantly.In our recurrent calcium oxalate cohort, age significantly impacted urinary calcium, oxalate, citrate, and pH. Along with gender and BMI, age can be used to predict key 24-hour urine stone risk results. These data lay the foundation for a risk prediction tool, which could be a surrogate for 24-hour urine results in recurrent stone formers, who are unwilling or unable to complete metabolic testing. Further validation of these findings is needed in other stone populations.

A 66-year-old Caucasian man with history of hypertension, hyperlipidaemia and 16 pack-year smoking was referred to us for evaluation of recurrent right-sided flank pain and suspected nephrolithiasis. His first episode of pain was 2 years prior to presentation, which was recurrent. There was no associated haematuria, dysuria, fever, chills, urinary hesitancy or incontinence. There was no family history of stones. He underwent multiple ureteroscopies, which have shown glistening, soft, acellular debris in the upper ureter. Last ureteroscopy and pyeloscopy showed normal underlying mucosa, renal pelvis and calyces with no evidence of malignancy. Subsequent MRI also did not show any malignancy. The last available pathology showed minute fragments of acellular keratin …