Relationship between maximum voided volume obtained by bladder diary compared to contemporaneous uroflowmetry in men and women.

INTRODUCTION: The 24-hour bladder diary is considered to be the gold standard for evaluating maximum voided volume (MVV). However, we observed that patients often have a greater MVV during office uroflowmetry than that seen in the bladder diary. The purpose of this study is to compare these two non-invasive methods by which MVV can be determined - at the time of uroflowmetry (Q-MVV), or by 24hour bladder diary (BD-MVV). MATERIALS AND METHODS: This was an Institutional Review Board approved retrospective study of patients evaluated for LUTS who completed a 24hour bladder diary and contemporaneous uroflowmetry. For Q-MVV, the patient was instructed to wait to void until their bladder felt full. Sample means were compared, and Pearson's correlations were calculated between the Q-MVV and BD-MVV data across the total sample, women, and men. RESULTS: Seven hundred seventy one patients with LUTS completed bladder diaries. Of these, 400 patients, 205 women and 195 men, had contemporaneous Q-MVV. Mean BD-MVV was greater than mean Q-MVV. However, Q-MVV was larger in a sizable minority of patients. There was a weak correlation between BD-MVV and Q-MVV. Furthermore, there was a difference ≥50% between Q-MVV and BD-MVV in 165 patients (41%). CONCLUSIONS: The data suggest that there is a difference between the two measurement tools, and that the BD-MVV was greater than Q-MVV. For a more reliable assessment of MVV, this study suggests that both Q-MVV and BD-MVV should be assessed and that the larger of the two values is a more reliable assessment of MVV.

Personalized Intervention in Monogenic Stone Formers.

PURPOSE: Treatment of a first-time renal stone consists of acute management followed by medical efforts to prevent stone recurrence. Although nephrolithiasis is roughly 50% heritable, the presence of a family history usually does not affect treatment since most stone disease is regarded as polygenic, ie not attributable to a single gene. Recent evidence has suggested that single mutations could be responsible for a larger proportion of renal stones than previously thought. This intriguing possibility holds the potential to change the management paradigm in stone prevention from metabolically directed therapy to more specific approaches informed by genetic screening and testing. This review synthesizes new findings concerning monogenic kidney stone disease, and provides a concise and clinically useful reference for monogenic causes. It is expected that increased awareness of these etiologies will lead to increased use of genetic testing in recurrent stone formers and further research into the prevalence of monogenic stone disease. MATERIALS AND METHODS: We assembled a complete list of genes known to cause or influence nephrolithiasis based on recent reviews and commentaries. We then comprehensively searched PubMed® and Google Scholar™ for all research on each gene having a pertinent role in nephrolithiasis. We determined which genes could be considered monogenic causes of nephrolithiasis. One gene, ALPL, was excluded since nephrolithiasis is a relatively minor aspect of the disorder associated with the gene (hypophosphatasia). We summarized selected studies and assembled clinically relevant details. RESULTS: A total of 27 genes were reviewed in terms of recent findings, mode of inheritance of stone disease, known or supposed prevalence of mutations in the general population of stone patients and specific therapies or considerations. CONCLUSIONS: There is a distinct opportunity for increased use of genetic testing to improve the lives of pediatric and adult stone patients. Several genes first reported in association with rare disease may be loci for novel mutations, heterozygous disease and forme frustes as causes of stones in the broader population. Cases of idiopathic nephrolithiasis should be considered as potentially having a monogenic basis.

Surgical treatment of detrusor underactivity: a short term proof of concept study.

OBJECTIVES: To compare the surgical outcomes of men with bladder outlet obstruction (BOO) due to benign prostatic obstruction (BPO) to those with detrusor underactivity (DU) or acontractile detrusor (DA). MATERIALS AND METHODS: This retrospective, IRB approved study included men who underwent BPO surgery for refractory LUTS or urinary retention. Patients were grouped based on videourodynamic (VUDS) findings: 1) men with BOO, 2) men with DU and 3) men with DA. The primary outcome measure was the Patient Global Impression of Improvement (PGII). Secondary outcome measures included uroflow (Qmax), post-void residual volume (PVR) and the need for clean intermittent catheterization (CIC). RESULTS: One hundred and nineteen patients were evaluated: 1) 34 with BOO, 2) 62 with DU and 3) 23 with DA. Subjective success rate (PGII) was highest in the BOO group (97%) and those with DU (98%), while DA patients had a PGII success of 26%, (p<0.0001). After surgery, patients with BOO had the lowest PVR (68.5mL). Fifty-six patients (47%) performed CIC pre-operatively (47% of BOO, 32% of DU and 87% of DA patients). None of the patients in the BOO and DU groups required CIC post operatively compared to16/23 (69%) of patients in the DA group (p<0.0001). CONCLUSIONS: BPO surgery is a viable treatment option in men with presumed BOO and DU while DA is a poor prognostic sign in men who do not void spontaneously pre-operatively.

Iatrogenic Paradoxical Stroke in a Patient With Catheter-Associated Thrombosis and Systemic-to-Pulmonary Venous Shunt.

Paradoxical embolism occurs when thrombotic material traverses a right-to-left shunt. We describe the first case of paradoxical stroke resulting from manipulation of a disused chemotherapy port. Contrast studies revealed that the mechanism was systemic-to-pulmonary venous shunt, in which systemic veins drain into the left atrium via collaterals. Chronically thrombosed central venous catheters may result in venous stenosis and shunt formation, exposing patients to risks of paradoxical stroke, acute coronary syndrome, hypoxemia, and other complications. This case highlights the life-threatening complications that may result from neglect of an implantable central venous catheter. Preventative measures are to promptly recognize and treat catheter-related thrombosis and to remove unneeded catheters.

Relationship between maximum voided volume obtained by bladder diary compared to contemporaneous uroflowmetry in men and women

ABSTRACT Introduction: The 24-hour bladder diary is considered to be the gold standard for evaluating maximum voided volume (MVV). However, we observed that patients often have a greater MVV during office uroflowmetry than that seen in the bladder diary. The purpose of this study is to compare these two non-invasive methods by which MVV can be determined - at the time of uroflowmetry (Q-MVV), or by 24hour bladder diary (BD-MVV). Materials and Methods: This was an Institutional Review Board approved retrospective study of patients evaluated for LUTS who completed a 24hour bladder diary and contemporaneous uroflowmetry. For Q-MVV, the patient was instructed to wait to void until their bladder felt full. Sample means were compared, and Pearson's correlations were calculated between the Q-MVV and BD-MVV data across the total sample, women, and men. Results: Seven hundred seventy one patients with LUTS completed bladder diaries. Of these, 400 patients, 205 women and 195 men, had contemporaneous Q-MVV. Mean BD-MVV was greater than mean Q-MVV. However, Q-MVV was larger in a sizable minority of patients. There was a weak correlation between BD-MVV and Q-MVV. Furthermore, there was a difference ≥50% between Q-MVV and BD-MVV in 165 patients (41%). Conclusions: The data suggest that there is a difference between the two measurement tools, and that the BD-MVV was greater than Q-MVV. For a more reliable assessment of MVV, this study suggests that both Q-MVV and BD-MVV should be assessed and that the larger of the two values is a more reliable assessment of MVV.

Single-Site Robotic Cholecystectomy at an Inner-City Academic Center.

INTRODUCTION: We investigate the safety and efficacy of single-site robotic cholecystectomy compared to laparoscopic cholecystectomy at an inner-city academic medical center. MATERIALS AND METHODS: Retrospective analysis comparing single-site robotic to laparoscopic cholecystectomies from August 1, 2013, to January 31, 2015, was conducted. Age, gender, race, body mass index (BMI), total operative time (docking and console time for robotic cases), length of stay, comorbidities, and conversion to open procedures were examined. The χ(2) and Student's t test were used for categorical and continuous data, respectively. A P ≤ 0.05 was considered statistically significant. RESULTS: From August 2013 to January 2015, 70 single-site robotic cholecystectomies and 70 laparoscopic cholecystectomies were performed. Patients were older (mean age, 40.3 years vs 47.6 years; P = .0084), had a higher mean BMI (29.5 vs 32.4 kg/m(2); P = .011), and had a higher assigned ASA (American Society of Anesthesiologists) classification (P = .024) in the laparoscopic than in the single-site group. Hypertension was more common in the laparoscopic group (P = .0078). Average docking time was 11.5 (SD 5.7) minutes, and the average console time was 52.8 (SD 22.5) minutes in the single-site group. Total operating time for the laparoscopic and single-site groups was not significantly different (111.5 minutes vs 106.0 minutes; P = .38). There were more conversions to open procedures in the laparoscopic compared to the single-site group (11 vs 1; P = .007). There were no biliary tree injuries and no deaths in either group. CONCLUSION: Single-site robotic cholecystectomy is safe to perform in an inner-city academic hospital setting. Surgical resident involvement does not adversely affect outcomes.

Surgical treatment of detrusor underactivity: a short term proof of concept study

ABSTRACT Objectives To compare the surgical outcomes of men with bladder outlet obstruction (BOO) due to benign prostatic obstruction (BPO) to those with detrusor underactivity (DU) or acontractile detrusor (DA). Materials and Methods This retrospective, IRB approved study included men who underwent BPO surgery for refractory LUTS or urinary retention. Patients were grouped based on videourodynamic (VUDS) findings: 1) men with BOO, 2) men with DU and 3) men with DA. The primary outcome measure was the Patient Global Impression of Improvement (PGII). Secondary outcome measures included uroflow (Qmax), post-void residual volume (PVR) and the need for clean intermittent catheterization (CIC). Results One hundred and nineteen patients were evaluated: 1) 34 with BOO, 2) 62 with DU and 3) 23 with DA. Subjective success rate (PGII) was highest in the BOO group (97%) and those with DU (98%), while DA patients had a PGII success of 26%, (p<0.0001). After surgery, patients with BOO had the lowest PVR (68.5mL). Fifty-six patients (47%) performed CIC pre-operatively (47% of BOO, 32% of DU and 87% of DA patients). None of the patients in the BOO and DU groups required CIC post operatively compared to16/23 (69%) of patients in the DA group (p<0.0001). Conclusions BPO surgery is a viable treatment option in men with presumed BOO and DU while DA is a poor prognostic sign in men who do not void spontaneously pre-operatively.