Urinary microbiome differences between lichen sclerosus induced and non-lichen sclerosus induced urethral stricture disease.

OBJECTIVE: To describe differences in the urinary microbiome of patients with pathologically confirmed lichen sclerosus (LS) urethral stricture disease (USD) vs non-lichen sclerosus (non-LS) USD pre- and post-operatively. METHODS: Patients were pre-operatively identified and prospectively followed, all underwent surgical repair and had tissue samples obtained to make a pathological diagnosis of LS. Pre- and post-operative urine samples were collected. Bacterial genomic DNA was extracted. Alpha and beta diversity measurements were calculated and compared. A zero-inflated negative binomial model was utilized to compare taxa abundances between disease status and surgery status. RESULTS: Urine samples were obtained from both cohorts, 69 samples in total: 36 samples were obtained pre-operatively and 33 samples were obtained post-operatively. Ten patients provided both a pre-operative and post-operative urine sample. Twenty-six patients had pathological evidence of LS and 33 patients did not. There was a statistically significant difference in alpha diversity between the pre-operative urine samples of patients with non-LS USD and LS USD, (p = 0.01). There was no significant difference in alpha diversity within post-operative urine samples between patients with non-LS USD and LS USD, (p = 0.1). A significant difference was observed in Weighed UniFrac distances with respect to disease and operative status, (p = 0.001 and 0.002). CONCLUSIONS: LS USD have significant alterations in diversity and differential abundance of urine microbiota compared to non-LS USD controls. These findings could be used to guide further investigations into the role of the urinary microbiome in LS USD pathogenesis, severity of presentation, and stricture recurrence.

A Review of Urinary Tract Endometriosis.

PURPOSE OF REVIEW: To describe the presenting signs and symptoms of patients with urinary tract endometriosis (UTE), appropriate workup, and to review medical and surgical therapies for symptom palliation and definitive management. RECENT FINDINGS: UTE is a condition that clinicians should maintain a high index of suspicion for, as symptoms can be easily misdiagnosed from other causes. Surgical resection of implants appears to offer safe and durable symptom relief. Urinary tract endometriosis may present with symptoms overlapping with interstitial cystitis, nephrolithiasis, bladder overactivity, or recurrent urinary tract infections, and may or may not be cyclical in nature. Cyclical gross hematuria is considered pathognomonic, though final diagnosis must be made after a pathologic review. Without proper diagnosis and treatment, consequences such as silent renal loss from asymptomatic obstruction may result. After the diagnosis is made, initial therapy can be undertaken with hormonal treatment to palliate symptoms (most commonly in the form of combined oral contraceptives), followed by surgical resection for a definitive treatment option.

Lower urinary tract injury: is urology consultation necessary?

PURPOSE: There is a paucity of data regarding urology involvement in the management of lower urinary tract injuries (LUTI). We seek to analyze the incidence and epidemiology of LUTI with special attention to trends in urology consultation. METHODS: A retrospective review was conducted of patients presenting to our Level I trauma center with LUTI from 2002 to 2016. Demographics, mechanism of injury, associated injuries, injury severity score (ISS), American Association for the Surgery of Trauma (AAST) injury scales, and clinical hospital course were analyzed. RESULTS: A total of 140 patients (0.47% of all trauma patients) were identified with LUTI, with 72.1% of these presenting with blunt trauma. Bladder injuries were more common than urethral injuries (79% vs. 14%) with 6% of patients having both. In-hospital mortality was 9.2% (13/140). Among patients with LUTI, 115 patients (82%) received urology consultation. There was no significant difference in sex, age, or LOS (hospital and ICU) between the groups. The consult group had a lower mean ISS (21.7 vs 27.9, p = 0.034), but a higher mean AAST bladder injury scale (2.57 vs 2.00, p = 0.016), than the non-consult group. There was a statistically significant difference in the diagnosis methods between the two groups (χ2 test of independence, p = 0.002). CONCLUSION: Urology service is important in the management of LUTI with high AAST injury scale. While further study is needed to look at degree of urology service involvement in the management of LUTI, we recommend a consultation for severe LUTI or when the management of injuries is out of the comfort zone of the trauma surgeons. Whether consultation is obtained or not, there is room for improvement in appropriate work up of lower urinary tract injury.

Histiocytic chorioretinitis in a dog.

A 3-year-old castrated male mixed-breed dog presented with an acute bullous retinal detachment and thickened choroid of the right eye. Subretinal cytology revealed an atypical cell proliferation suggestive of neoplasia. The eye was enucleated, and the original diagnosis was a histologically benign choroidal melanocytic tumor. Further diagnostics revealed no other systemic abnormalities other than a nonhealing shoulder wound. Six months later, the left eye developed a bullous retinal detachment. This eye responded well to systemic steroids and the dog regained vision within a few weeks of initiating therapy. Results of immunohistochemistry with Melan-A and CD204 of the previously enucleated right eye caused a revision of the histologic diagnosis from melanocytic tumor to histiocytic chorioretinitis. This case highlights the subtle and sometimes confusing distinction between neoplastic and inflammatory processes on both cytology and histopathology.

Effect of bone marrow-derived mesenchymal stem cells and stem cell supernatant on equine corneal wound healing in vitro.

BACKGROUND: We aimed to determine and compare the in vitro effects of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) and mesenchymal stem cell supernatant (MSC-Sp) on the wound healing capacity of equine corneal fibroblasts using a scratch assay. METHODS: Bone marrow aspirates and eyes were collected from normal, euthanized horses with subsequent isolation and culture of BM-MSCs and corneal stromal cells. Corneal stromal cells were culture-expanded in the culture well of transwell plates and then treated with an autologous BM-MSC suspension (dose: 2.5 × 105/100 µL media with the BM-MSCs contained within the insert well), MSC-Sp solution, or naive culture media (control) for 72 h. A linear defect in confluent cell cultures was created (i.e., corneal scratch assay) to assess the cellular closure ("healing") over time. Three representative areas of the scratch in each culture were photographed at each time point and the scratch area was quantitated using image analysis software (ImageJ). Media from the scratches were analyzed for various growth factors using human enzyme-linked immunosorbent assay (ELISA) kits that crossreact with the horse. RESULTS: There was a significant percentage decrease in the scratch area remaining in the BM-MSC and MSC-Sp groups compared to the control group. There was also a significant percentage decrease in the scratch area remaining in the BM-MSC group compared to the MSC-Sp group at 36 h post-scratch and all time points thereafter. The concentration of transforming growth factor (TGF)-ß1 in the media was significantly higher in the BM-MSC group compared to the control group. CONCLUSIONS: The significant decrease in scratch area in equine corneal fibroblast cultures treated with autologous BM-MSCs compared to MSC-Sp or control treatments suggests that BM-MSCs may substantially improve corneal wound healing in horses. MSC-Sp may also improve corneal wound healing given the significant decrease in scratch area compared to control treatments, and would be an immediately available and cost-effective treatment option.

Impact of fungal species cultured on outcome in horses with fungal keratitis.

PURPOSE: To determine the significance of Aspergillus and Fusarium spp., as identified by culture, on clinical outcome in equine keratomycosis. METHODS: Retrospective analysis of 66 horses (66 eyes) evaluated at the NCSU-VH diagnosed with keratomycosis from which Aspergillus or Fusarium spp. were cultured. Horses were classified into those who improved with medical management alone or those who required surgical intervention to improve. Horses who underwent surgery were divided into globe-sparing procedures or enucleation. Effects of bacterial co-infection, previous topical steroid or antifungal use, and time of year on fungal genus and outcome were evaluated. RESULTS: Aspergillus spp. was cultured from 41 eyes (63%), while 24 eyes (37%) cultured Fusarium spp. One horse cultured both species and was not included in further evaluation. From the horses that cultured Aspergillus spp., 28 eyes (68%) required surgical intervention to control the infection: 21 (75%) of these eyes maintained globe integrity, while 7 eyes (25%) were enucleated. Of those horses with Fusarium spp., 14 eyes (58%) required surgical intervention: 11 (79%) of these eyes maintained globe integrity, while 3 eyes (21%) were enucleated. Genus of fungus cultured was not significantly associated with the need for surgical intervention nor was it significantly associated with the necessity of globe-sparing surgery versus enucleation. Additionally, bacterial co-infection, previous steroidal or antifungal use, and time of year did not affect outcome or type of fungal species cultured. CONCLUSION: Equine keratomycosis from Fusarium spp. compared to keratomycosis from Aspergillus spp. is not associated with a different clinical outcome.