Investigating trends in interest for benign prostatic hyperplasia surgery options using Google Trends.

Understanding patient interest among surgical options is challenging. We used Google Trends to analyze interest in benign prostatic hyperplasia (BPH) surgeries recommended for prostate volumes <80 cc. Google Trends was queried with five BPH surgeries. Final rank of search terms was TURP, UroLift, Rezum, Aquablation, and Greenlight. Google Trends can be an effective tool for evaluating public interest trends in BPH surgery.

Tipless Nitinol Stone Baskets: Comparison of Penetration Force, Radial Dilation Force, Opening Dynamics, and Deflection.

OBJECTIVE: To evaluate 5 commercially available tipless nitinol baskets (2.2F) in 4 performance factors: penetration force, radial dilation force, opening dynamics, and deflection limitation. MATERIALS AND METHODS: The 2.2F Coloplast Dormia No-Tip, 1.5F Sacred Heart Medical Halo, 2.2F Cook NCircle Nitinol Tipless Stone Extractor, 1.9F Bard SkyLite Tipless Nitinol Basket, and 1.9F Boston Scientific Zero Tip Nitinol Stone Retrieval Basket were tested for penetration force (safety metric), radial dilation force (functional metric for ureteral calculi), and opening or closing dynamics. Limitation of deflection (functional metric) was tested by measuring the difference in maximal upward and downward angle of deflection of a ureteroscope with and without a basket in place. RESULTS: The Sacred Heart Medical Halo 1.5F basket had the highest mean force required to perforate the foil at 0.676N ± 0.117 (P < .0001). The Sacred Heart Medical Halo 1.5F basket also had the highest mean radial dilation force at 3.04 g ± 0.15 (P < .0001). The Cook NCircle Nitinol Tipless Stone Extractor 2.2F had the most linear pattern of opening, whereas the Coloplast Dormia No-Tip 2.2F and the Sacred Heart Medical Halo 1.5F exhibited exponential opening dynamics. The Cook NCircle Nitinol Tipless Stone Extractor 2.2F limited scope deflection the most with a decrease in 4° downward and 10° upward. The Sacred Heart Medical Halo 1.5F had the least influence on deflection with a decrease in 3° downward and 5° upward. CONCLUSION: The penetration force, radial dilation force, opening dynamics, and resistance to deflection varied between 5 commonly available tipless nitinol stone baskets. A small diameter 1.5F basket is capable of providing optimal performance while sacrificing linear opening.

Multicenter External Validation and Comparison of Stone Scoring Systems in Predicting Outcomes After Percutaneous Nephrolithotomy.

BACKGROUND AND PURPOSE: Several scoring systems have recently emerged to predict stone-free rate (SFR) and complications after percutaneous nephrolithotomy (PCNL). We aimed to compare the most commonly used scoring systems (Guy's stone score, S.T.O.N.E. nephrolithometry, and CROES nomogram), assess their predictive accuracy for SFR and other postoperative variables, and develop a risk group stratification based on these scoring systems. MATERIALS AND METHODS: We performed a retrospective review of patients who have had a PCNL at four academic institutions between 2006 and 2013. Primary outcome was SFR within 3 weeks of the surgery and secondary outcomes were operative time (OT), complications, and length of stay (LOS). We performed chi-squared, t-test, logistic, linear, and Poisson regressions, as well as receiver operating characteristics curve with area under the curve (AUC) calculation. RESULTS: We identified 586 patients eligible for analysis. Of these, 67.4% were stone free. Guy's, S.T.O.N.E., and CROES score were predictive of SFR on multivariable logistic regression (odds ratio [OR]: 1.398, 95% confidence interval [CI]: 1.056, 1.852, p = 0.019; OR: 1.417, 85% CI: 1.231, 1.631, p < 0.001; OR: 0.993, 95% CI: 0.988, 0.998, p = 0.004) and have similar predictive accuracy with AUCs of 0.629, 0.671, and 0.646, respectively. On multivariable linear regression, only S.T.O.N.E. was an independent predictor of longer OT (ß = 14.556, 95% CI: 12.453, 16.660, p < 0.001). None of the scores were independent predictors of postoperative complications or a longer LOS. Poisson regression allowed for risk group stratification and showed the S.T.O.N.E. score and CROES nomogram to have the most distinct risk groups. CONCLUSIONS: The three evaluated scoring systems have similar predictive accuracy of SFR. S.T.O.N.E. has additional value in predicting OT. Risk group stratification can be used for patient counseling. Further research is needed to identify whether or not any is superior to the others with regard to clinical usefulness and predictive accuracy.

Evaluation and comparison of urolithiasis scoring systems used in percutaneous kidney stone surgery.

PURPOSE: Contemporary predictive tools for percutaneous nephrolithotomy outcomes include the Guy stone score, S.T.O.N.E. nephrolithometry and the CROES nephrolithometric nomogram. We compared each scoring system in the same cohort to determine which was most predictive of surgical outcomes. METHODS: We retrospectively reviewed the records of patients who underwent percutaneous nephrolithotomy between 2009 and 2012 at a total of 3 academic institutions. We calculated the Guy stone score, the S.T.O.N.E. nephrolithometry score and the CROES nephrolithometric nomogram score based on preoperative computerized tomography images. A single observer at each institution reviewed all images and assigned scores. Univariate and multivariate analysis was done to determine the most predictive scoring system. RESULTS: We enrolled 246 patients in study. In stone-free patients vs those with residual stones the mean Guy score was 2.2 vs 2.7, the mean S.T.O.N.E. score was 8.3 vs 9.5 and the mean CROES nomogram score was 222 vs 187 (each p <0.001). Logistic regression revealed that the Guy, S.T.O.N.E. nephrolithometry and CROES nomogram scores were significantly associated with stone-free status (p = 0.02, 0.004 and <0.001, respectively). The Guy and S.T.O.N.E. nephrolithometry scores were associated with estimated blood loss (p <0.0001 and 0.03) and length of stay (p = 0.03 and 0.009, respectively). The CROES nomogram did not predict estimated blood loss or length of stay. CONCLUSIONS: All scoring systems and the stone burden equally predicted stone-free status. The Guy and S.T.O.N.E. nephrolithometry scores were associated with estimated blood loss and length of stay. A single scoring system should be adopted to unify reporting.

Xp11 Translocation Renal Cell Carcinoma: Unusual Variant Masquerading as Upper Tract Urothelial Cell Carcinoma.

Xp11 translocation renal cell carcinoma (TRCC) is a rare subtype of renal cell carcinoma characterized by chromosomal translocations involving the TFE3 gene located at the Xp11.2 locus. Initial cases were more common in children, but cases in older adults have begun to accrue and suggest a relatively more aggressive course. We report a case of Xp11 TRCC in a 63-year-old female patient with initial presentation mimicking upper urinary tract urothelial cell carcinoma, with biopsy proving TRCC. She underwent a radical nephrectomy and paracaval lymph node dissection and is followed up with the intent to initiate vascular endothelial growth factor-targeted therapy in case of recurrence.

Tumour-seeding: a rare complication of ablative therapy for clinically localised renal cell carcinoma.

Current evidence-based clinical practice guidelines identify surgical resection as the recommended treatment of small renal masses. Ablative approaches such as laparoscopic and percutaneous cryoablation and radiofrequency ablation offer the promise of complete tumour destruction by a less-invasive approach with regard to outcomes such as anaesthesia requirements, blood loss, length of stay and time to recovery, making them appealing to patients. However, evidence of therapeutic benefits, harms and costs for these methods remains limited. We report a case of applicator tract seeding by tumour following percutaneous cryoablation of renal cell carcinoma; a rare and potentially under-reported, yet catastrophic complication of ablative therapy.

SLC26 anion exchangers of guinea pig pancreatic duct: molecular cloning and functional characterization.

The secretin-stimulated human pancreatic duct secretes HCO(3)(-)-rich fluid essential for normal digestion. Optimal stimulation of pancreatic HCO(3)(-) secretion likely requires coupled activities of the cystic fibrosis transmembrane regulator (CFTR) anion channel and apical SLC26 Cl(-)/HCO(3)(-) exchangers. However, whereas stimulated human and guinea pig pancreatic ducts secrete ∼140 mM HCO(3)(-) or more, mouse and rat ducts secrete ∼40-70 mM HCO(3)(-). Moreover, the axial distribution and physiological roles of SLC26 anion exchangers in pancreatic duct secretory processes remain controversial and may vary among mammalian species. Thus the property of high HCO(3)(-) secretion shared by human and guinea pig pancreatic ducts prompted us to clone from guinea pig pancreatic duct cDNAs encoding Slc26a3, Slc26a6, and Slc26a11 polypeptides. We then functionally characterized these anion transporters in Xenopus oocytes and human embryonic kidney (HEK) 293 cells. In Xenopus oocytes, gpSlc26a3 mediated only Cl(-)/Cl(-) exchange and electroneutral Cl(-)/HCO(3)(-) exchange. gpSlc26a6 in Xenopus oocytes mediated Cl(-)/Cl(-) exchange and bidirectional exchange of Cl(-) for oxalate and sulfate, but Cl(-)/HCO(3)(-) exchange was detected only in HEK 293 cells. gpSlc26a11 in Xenopus oocytes exhibited pH-dependent Cl(-), oxalate, and sulfate transport but no detectable Cl(-)/HCO(3)(-) exchange. The three gpSlc26 anion transporters exhibited distinct pharmacological profiles of (36)Cl(-) influx, including partial sensitivity to CFTR inhibitors Inh-172 and GlyH101, but only Slc26a11 was inhibited by PPQ-102. This first molecular and functional assessment of recombinant SLC26 anion transporters from guinea pig pancreatic duct enhances our understanding of pancreatic HCO(3)(-) secretion in species that share a high HCO(3)(-) secretory output.

Regulated transport of sulfate and oxalate by SLC26A2/DTDST.

Nephrolithiasis in the Slc26a6(-/-) mouse is accompanied by 50-75% reduction in intestinal oxalate secretion with unchanged intestinal oxalate absorption. The molecular identities of enterocyte pathways for oxalate absorption and for Slc26a6-independent oxalate secretion remain undefined. The reported intestinal expression of SO(4)(2-) transporter SLC26A2 prompted us to characterize transport of oxalate and other anions by human SLC26A2 and mouse Slc26a2 expressed in Xenopus oocytes. We found that hSLC26A2-mediated [(14)C]oxalate uptake (K(1/2) of 0.65 +/- 0.08 mM) was cis-inhibited by external SO(4)(2-) (K(1/2) of 3.1 mM). hSLC26A2-mediated bidirectional oxalate/SO(4)(2-) exchange exhibited extracellular SO(4)(2-) K(1/2) of 1.58 +/- 0.44 mM for exchange with intracellular [(14)C]oxalate, and extracellular oxalate K(1/2) of 0.14 +/- 0.11 mM for exchange with intracellular (35)SO(4)(2-). Influx rates and K(1/2) values for mSlc26a2 were similar. hSLC26A2-mediated oxalate/Cl(-) exchange and bidirectional SO(4)(2-)/Cl(-) exchange were not detectably electrogenic. Both SLC26A2 orthologs exhibited nonsaturable extracellular Cl(-) dependence for efflux of intracellular [(14)C]oxalate, (35)SO(4)(2-), or (36)Cl(-). Rate constants for (36)Cl(-) efflux into extracellular Cl(-), SO(4)(2-), and oxalate were uniformly 10-fold lower than for oppositely directed exchange. Acidic extracellular pH (pH(o)) inhibited all modes of hSLC26A2-mediated anion exchange. In contrast, acidic intracellular pH (pH(i)) selectively activated exchange of extracellular Cl(-) for intracellular (35)SO(4)(2-) but not for intracellular (36)Cl(-) or [(14)C]oxalate. Protein kinase C inhibited hSLC26A2 by reducing its surface abundance. Diastrophic dysplasia mutants R279W and A386V of hSLC26A2 exhibited similar reductions in uptake of both (35)SO(4)(2-) and [(14)C]oxalate. A386V surface abundance was reduced, but R279W surface abundance was at wild-type levels.

The GPA-dependent, spherostomatocytosis mutant AE1 E758K induces GPA-independent, endogenous cation transport in amphibian oocytes.

The previously undescribed heterozygous missense mutation E758K was discovered in the human AE1/SLC4A1/band 3 gene in two unrelated patients with well-compensated hereditary spherostomatocytic anemia (HSt). Oocyte surface expression of AE1 E758K, in contrast to that of wild-type AE1, required coexpressed glycophorin A (GPA). The mutant polypeptide exhibited, in parallel, strong GPA dependence of DIDS-sensitive (36)Cl(-) influx, trans-anion-dependent (36)Cl(-) efflux, and Cl(-)/HCO(3)(-) exchange activities at near wild-type levels. AE1 E758K expression was also associated with GPA-dependent increases of DIDS-sensitive pH-independent SO(4)(2-) uptake and oxalate uptake with altered pH dependence. In marked contrast, the bumetanide- and ouabain-insensitive (86)Rb(+) influx associated with AE1 E758K expression was largely GPA-independent in Xenopus oocytes and completely GPA-independent in Ambystoma oocytes. AE1 E758K-associated currents in Xenopus oocytes also exhibited little or no GPA dependence. (86)Rb(+) influx was higher but inward cation current was lower in oocytes expressing AE1 E758K than previously reported in oocytes expressing the AE1 HSt mutants S731P and H734R. The pharmacological inhibition profile of AE1 E758K-associated (36)Cl(-) influx differed from that of AE1 E758K-associated (86)Rb(+) influx, as well as from that of wild-type AE1-mediated Cl(-) transport. Thus AE1 E758K-expressing oocytes displayed GPA-dependent surface polypeptide expression and anion transport, accompanied by substantially GPA-independent, pharmacologically distinct Rb(+) flux and by small, GPA-independent currents. The data strongly suggest that most of the increased cation transport associated with the novel HSt mutant AE1 E758K reflects activation of endogenous oocyte cation permeability pathways, rather than cation translocation through the mutant polypeptide.