Publications by authors named "Charles Upshur Nottingham"

4 Publications

  • Page 1 of 1

Multi-institutional Prospective Randomized Control Trial of Novel Intracorporeal Lithotripters: ShockPulse-SE vs TrilogyTM Trial.

J Endourol 2021 Apr 11. Epub 2021 Apr 11.

Indiana University School of Medicine, 12250, Urology, 1801 Senate Blvd. #220, Indianapolis, Indiana, United States, 46202;

Introduction: Currently, there are multiple intracorporeal lithotripters available for use in percutaneous nephrolithotomy (PCNL). This study aimed to evaluate the efficiency of two novel lithotripters; TrilogyTM and ShockPulse-SE.

Methods: This is a prospective, multi-institutional, randomized trial comparing outcomes of PCNL using two novel lithotripters between February 2019 and June 2020. The study assessed objective measures of stone clearance time, stone clearance rate, device malfunction, stone-free rates, and complications. Device assessment was provided via immediate postoperative survey by primary surgeons.

Results: There were 100 standard PCNLs completed using either a TrilogyTM or ShockPulse-SE lithotrite. Using quantitative Stone Analysis Software to estimate stone volume, the mean stone volume was calculated at 4.18 ± 4.79 cm3 and 3.86 ± 3.43 cm3 for the Trilogy and ShockPulse-SE groups respectively . Stone clearance rates were found to be 1.22 ± 1.67 and 0.77 ± 0.68 cm3/min for TrilogyTM versus ShockPulse-SE (p=0.0542). When comparing TrilogyTM to ShockPulse-SE in a multivariate analysis, total OR time (104.4 ± 48.2 vs 121.1 ± 59.2 min p=0.126), rates of secondary procedures (17.65% vs 40.81% p=0.005), and device malfunctions (1.96% vs 34.69% p<0.001), were less, respectively. There was no difference in final stone free rates between devices.

Conclusion: The TrilogyTM lithotripter removed stones significantly faster than previous generations of intracorporeal lithotripters. In the case of large stones the efficiency of the TrilogyTM device optimizes clearance and operating times.
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http://dx.doi.org/10.1089/end.2020.1097DOI Listing
April 2021

Comparison of Newly-Optimized Moses Technology Versus Standard Holmium:YAG for Endoscopic Laser Enucleation of the Prostate.

J Endourol 2021 Apr 3. Epub 2021 Apr 3.

Northwestern University Feinberg School of Medicine, 12244, Urology, Chicago, Illinois, United States;

Introduction: The purpose of this study was to describe our initial experience of using a newly-optimized Moses technology that is part of the second generation Moses platform specifically designed for holmium laser enucleation of the prostate M2-HoLEP, and compare it to patients undergoing holmium laser enucleation of the prostate (HoLEP) using standard holmium:YAG technology (S-HoLEP).

Methods: We retrospectively collected data on patients who underwent M2-HoLEP and compared it to the last 50 patients in whom we performed S-HoLEP. Specifically, we compared preoperative symptom scores for lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), preoperative objective voiding metrics, as well as intraoperative characteristics, perioperative characteristics, postoperative complications, postoperative symptom scores for LUTS and ED, and postoperative objective voiding metrics. Additionally we evaluated the ability for same day discharge following surgery in the M2-HoLEP group.

Results: We included 104 total patients for analysis. We compared the first 54 patients undergoing M2-HoLEP to 50 patients undergoing S-HoLEP. Both groups had similar age, BMI, use of anticoagulation medication, LUTS and ED scores, and objective voiding metrics. Operations performed with M2-HoLEP had faster mean hemostasis time (8.7 vs 10.6 ± 6 minutes, p=0.03) as well as hemostasis rate (0.13 vs 0.30 grams/minute, p=0.01). Same day discharge was successful in 69.4% of patients in the M2-HoLEP group. Postoperatively, both groups also had similar and low rates of urinary retention and complications. At follow-up, both groups had similar symptom scores for LUTS and ED, as well as similar objective voiding metrics.

Conclusion: The newly optimized Moses pulse modulation technology is safe and efficient for the treatment of BPH. Such technologic improvements in the laser have greatly enhanced the feasibility of same day discharge of patients undergoing HoLEP.
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http://dx.doi.org/10.1089/end.2020.0996DOI Listing
April 2021

Clinical and Metabolic Correlates of Pure Stone Subtypes.

J Endourol 2021 Feb 11. Epub 2021 Feb 11.

Indiana University School of Medicine, 12250, Urology, 1801 Senate Blvd. #220, Indianapolis, Indiana, United States, 46202;

: There are multiple stone types, each forming under different urinary conditions. We compared clinical and metabolic findings in pure stone formers to understand if there are consistent factors that differentiate these groups in terms of underlying etiology and potential for empiric treatment. : Pure SFs based on infrared spectroscopic analysis of stones obtained at our institution between 01/2002 and 07/2018 with a corresponding 24-hour urinalysis were retrospectively evaluated. : 121 apatite, 54 brushite, 50 calcium oxalate dihydrate, 104 calcium oxalate monohydrate, and 82 uric acid patients were analyzed. Apatite, brushite, and calcium oxalate dihydrate patients were younger than calcium oxalate monohydrate and uric acid patients. Uric acid patients had the highest male predominance (76.8%), while apatite patients were predominantly female (80.2%). Uric acid was most associated with diabetes mellitus (45.3%), and calcium oxalate monohydrate with cardiovascular disease (27.2%) and malabsorptive gastrointestinal conditions (19.2%). Brushite patients had the highest prevalence of primary hyperparathyroidism (17%). Apatite, brushite, and calcium oxalate dihydrate patients demonstrated high rates of hypercalciuria (66.1%, 79.6%, 82%). Apatite and brushite patients had the highest urinary pH. Apatite patients exhibited the highest rate of hypocitraturia while calcium oxalate dihydrate patients exhibited the lowest (55.4%, 30%). Calcium oxalate monohydrate patients had the highest rate of hyperoxaluria (51.9%). Uric acid patients had the lowest urinary pH. There were no observable differences in the rates of hyperuricosuria or hypernatriuria. : These results demonstrate that pure stone composition correlates with certain urinary and clinical characteristics. This data can help guide empiric clinical decision-making.
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http://dx.doi.org/10.1089/end.2020.1035DOI Listing
February 2021

How the lack of consensus among stone researchers influences current guidelines.

Nat Rev Urol 2020 Sep;17(9):483-484

Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.

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http://dx.doi.org/10.1038/s41585-020-0317-9DOI Listing
September 2020