Publications by authors named "Ryan Paterson"

84 Publications

WATER versus WATER II 2-Year Update: Comparing Aquablation Therapy for Benign Prostatic Hyperplasia in 30-80-cm and 80-150-cm Prostates.

Eur Urol Open Sci 2021 Mar 31;25:21-28. Epub 2021 Jan 31.

Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.

Background: Surgical options are limited when treating large (>80 cm) prostates for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Open simple prostatectomy remains the most common procedure performed for large prostates. There is a need for novel surgical approaches with shorter learning curves and effective treatment. Aquablation could be this novel tool.

Objective: To compare the outcome of Aquablation for 30-80-cm prostates with the outcome for 80-150-cm prostates at 2-yr follow-up.

Design Setting And Participants: We used data from two trials. WATER is a prospective, double-blind, multicenter, international clinical trial comparing the safety and efficacy of Aquablation and transurethral resection of the prostate in the treatment of LUTS/BPH in men aged 45-80 yr with a prostate of 30-80 cm. WATER II is a prospective, multicenter, single-arm international clinical trial of Aquablation in men with a prostate of 80-150 cm.

Intervention: Aquablation, an ultrasound-guided, robotically executed waterjet ablative procedure.

Outcome Measurements And Statistical Analysis: We compared 24-mo outcomes between 116 WATER and 101 WATER II study subjects. Student's test or a Wilcoxon test was used to compare continuous variables and Fisher's test for categorical variables.

Results And Limitations: The International Prostate Symptom Score (IPSS) reductions at 24 mo was 14.5 points for WATER and 17.4 points for WATER II ( = 0.31). At baseline, the maximum urinary flow rate (Q) was 9.4 and 8.7 cm/s in WATER and WATER II, improving to 20.5 and 18.2 cm/s, respectively ( = 0.60) at 24 mo. Improvements in both IPSS and Q were immediate and sustained throughout follow-up. At 2 yr, the surgical retreatment rate was 4% in WATER and 2% in WATER II.

Conclusions: Aquablation is effective in patients with a prostate of 30-80 cm and patients with a prostate of 80-150 cm treated for LUTS/BPH, with comparable outcomes in both groups. It has low complication and retreatment rates at 2 yr of follow-up, with durable improvements in functional outcome.

Patient Summary: Outcomes of Aquablation for both small-to-moderately-sized and large prostates are similar and sustainable at 2 yr of follow-up.
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http://dx.doi.org/10.1016/j.euros.2021.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317818PMC
March 2021

Predictors of urosepsis in struvite stone patients after percutaneous nephrolithotomy.

Investig Clin Urol 2021 Mar;62(2):201-209

Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.

Purpose: This study aims to identify clinical factors that may predispose struvite stone patients to urosepsis following percutaneous nephrolithotomy (PCNL).

Materials And Methods: A retrospective review was conducted on patients who received PCNL for struvite stones. The Systemic Inflammatory Response Syndrome (SIRS) criteria and quick-Sepsis Related Organ Failure Assessment (q-SOFA) criteria were used to identify patients who were at an increased risk for urosepsis. Statistical analysis was performed using Fisher's exactness test, Wilcoxon rank test, and logistic regression.

Results: Chart review identified 99 struvite stone patients treated with PCNL. Post-operatively, 40 patients were SIRS positive (≥2 criteria) and/or q-SOFA positive (score ≥2). Using SIRS as an approximation for urosepsis, longer operative times (p<0.001), higher pre-operative white blood cell counts (p=0.01), greater total stone surface area (p<0.0001), and pre-operative stenting (OR, 5.75; p=0.01) were identified as independent risk factors for urosepsis. Multivariate analysis demonstrated pre-operative stenting (OR, 1.46; p=0.01) to be a risk factor. With q-SOFA, univariable analysis found that antibiotic use within 3 months prior to a PCNL (OR, 4.44; p=0.04), medical comorbidities (OR, 4.80; p=0.02), longer operative times (p<0.001), lengthier post-operative hospitalization (p<0.01), and greater total stone surface area (p<0.0001) were risk factors for urosepsis. Multivariate analysis revealed that bladder outlet obstruction (OR, 2.74; p<0.003) and pre-operative stenting (OR, 1.27; p=0.01) significantly increased odds of being q-SOFA positive.

Conclusions: Several risk factors for urosepsis following PCNL for struvite stones have been identified. These risk factors should be taken into consideration in peri-operative care to mitigate the risks of urosepsis.
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http://dx.doi.org/10.4111/icu.20200319DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940850PMC
March 2021

Use of rituximab in idiopathic retroperitoneal fibrosis.

BMC Rheumatol 2020 6;4:40. Epub 2020 Aug 6.

Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada.

Background: Retroperitoneal fibrosis (RPF) is characterized by the proliferation of fibrous tissue in the retroperitoneum. The majority of RPF cases are due to idiopathic or IgG4-related disease. Recent studies on IgG4-related disease have shown rituximab to be an effective treatment. The current first-line treatment for idiopathic RPF (iRPF) is glucocorticoid therapy. Relapse rates vary widely in the literature, and DMARDs remain poorly studied. We sought to evaluate the efficacy of rituximab in idiopathic RPF by quantifying changes in iRPF diameter on imaging pre- and post-rituximab therapy and response by lab parameters in 10 iRPF patients.

Methods: We selected 10 patients diagnosed with iRPF and previously treated with rituximab (1000 mg) in two doses approximately 2 weeks apart. Pre- and post-therapy contrast enhanced cross-sectional abdomen and pelvis imaging were compared. In all patients, the thickest portion of the peri-aortic disease was measured in the axial and coronal planes. The presence of acute or long standing back pressure related renal findings were documented. Details of clinical visits including patient demographics and laboratory evaluations were collected pre- and post-therapy. Statistical analysis was performed using a Wilcoxon signed rank test.

Results: The RPF diameter around the aorta before and after therapy decreased from a mean of 15.9 ± 4.9 mm to 10.6 ± 6.1 mm, respectively ( < 0.01). The craniocaudal iRPF mean length decreased from 108.6 mm ± 40.4 mm to 90.6 mm ± 45.9 mm ( = 0.02).

Conclusion: A comparison of pre and post-rituximab imaging studies revealed a statistically significant decrease in iRPF diameter following treatment with rituximab.
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http://dx.doi.org/10.1186/s41927-020-00140-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409628PMC
August 2020

Aquablation for benign prostatic hyperplasia in large prostates (80-150 cc): 2-year results.

Can J Urol 2020 04;27(2):10147-10153

University of Southern California, Institute of Urology, Los Angeles, California, USA.

Introduction: To report 2-year safety and effectiveness of the Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH) and large-volume 80-150 cc prostates.

Materials And Methods: Between September-December 2017, 101 men with moderate-to-severe BPH symptoms and prostate volumes of 80-150 cc underwent an ultrasound-guided robotically executed Aquablation procedure in a prospective multicenter international clinical trial (WATER II). Baseline, procedural and follow up parameters were recorded at baseline and scheduled postoperative visits. Herein we report 2-year safety and efficacy for this cohort.

Results: Mean prostate volume was 107 cc (range 80-150 cc). Mean IPSS improved from 23.2 at baseline to 5.8 at 2 years (17-point improvement, p < .0001). Mean IPSS quality of life improved from 4.6 at baseline to 1.1 at 2 years (p < .0001). Maximum urinary flow increased from 8.7 to 18.2 cc/sec. Two subjects underwent a repeat procedure for BPH symptoms over the 2-year follow up period. By 2 years or study exit, all but 2 of 74 subjects stopped taking alpha blockers. Similarly, all but 4 of 32 subjects stopped taking 5α-reductase inhibitors.

Conclusions: Two-year prospective multicenter follow up demonstrated that the Aquablation procedure is safe and effective in the treatment of men with LUTS due to BPH and prostates 80-150 cc with durable treatment efficacy, acceptable safety profile and a low retreatment rate. ClinicalTrials.gov number, NCT03123250.
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April 2020

Waterjet Ablation Therapy for Endoscopic Resection of prostate tissue trial (WATER) vs WATER II: comparing Aquablation therapy for benign prostatic hyperplasia in 30-80 and 80-150 mL prostates.

BJU Int 2020 01 8;125(1):112-122. Epub 2019 Nov 8.

Centre Hospitalier de l'Université de Montréal, Division of Urology, Montreal, QC, Canada.

Objective: To compare the outcomes of Aquablation in 30-80 mL prostates with those in 80-150 mL prostates. Surgical options, especially with short learning curves, are limited when treating large prostates for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Aquablation (AquaBeam System, PROCEPT BioRobotics Inc., Redwood City, CA, USA) could solve this issue with global reproducibility, independent of prostate volume.

Patients And Methods: Waterjet Ablation Therapy for Endoscopic Resection of prostate tissue (WATER [W-I]; NCT02505919) is a prospective, double-blind, multicentre, international clinical trial comparing Aquablation and transurethral resection of the prostate (TURP) for the treatment of LUTS/BPH in prostates between 30 and 80 mL. WATER II (W-II; NCT03123250) is a prospective, multicentre, single-arm international clinical trial of Aquablation in prostates between 80 and 150 mL. We compare baseline parameters and 12-month outcomes in 116 W-I and 101 W-II study patients. Students' t-test or Wilcoxon tests were used for continuous variables and Fisher's test for binary variables.

Results: The mean (SD) operative time was 33 (17) and 37 (13) min in W-I and W-II, respectively. Actual treatment time was 4 and 8 min in W-I and W-II, respectively. The mean change in the International Prostate Symptom Score was substantial averaging (at 12 months) 15.1 in W-I and 17.1 in W-II (P = 0.605). By 3 months, Clavien-Dindo grade ≥II events occurred in 19.8% of W-I patients and 34.7% of W-II patients (P = 0.468).

Conclusion: Aquablation clinically normalises outcomes between patients with 30-80 mL prostates and patients with 80-150 mL prostates treated for LUTS/BPH, with an expected increase in the risk of complications in larger prostates. Long-term outcomes of procedure durability are needed.
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http://dx.doi.org/10.1111/bju.14917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6972548PMC
January 2020

Introduction of an ex-vivo pig model for teaching percutaneous nephrolithotomy access techniques.

Can Urol Assoc J 2019 Oct;13(10):355-360

Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.

Introduction: In North America, obtaining access for percutaneous nephrolithotomy (PCNL) is not often performed by urologists. Hands-on training sessions help to ensure this skill continues within the urological community. An ex-vivo pig kidney model was developed for simulation. This model uses porcine tissues with a fluoroscopic C-arm and standard PCNL equipment. The bullseye or triangulation techniques are both possible. We propose this as a high-fidelity tool for teaching PCNL access.

Methods: The pig kidney, fat, ribs, flank, and skin were arranged anatomically on a table with fluoroscopy. Hands-on training was provided to residents and urologists using the ex-vivo pig model and a silicone-based percutaneous access model. Questionnaires were given at the end of the session.

Results: There was a total 14 responders for each model, with incomplete responses on two surveys. A total of 15% of responders for the pig model and 7% of responders for the silicone model had previous percutaneous access experience. For the pig model, 93% of trainees agreed or strongly agreed that the model was easy to use, and 79% of the silicone model trainees felt the same. After the session, 50% of silicone model trainees and 86% of pig model trainees reported increased confidence in their ability to obtain PCNL access. All the pig model trainees and 71% of the silicone model trainees felt that the simulation activity was worthwhile.

Conclusions: The inexpensive but anatomically realistic ex-vivo pig model using real-world equipment provides trainees with an excellent tool to learn PCNL access.
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http://dx.doi.org/10.5489/cuaj.5717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788908PMC
October 2019

Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results.

Urology 2019 Jul 3;129:1-7. Epub 2019 May 3.

UT Southwestern Medical Center, Department of Urology, University of Texas Southwestern, Dallas, TX.

Objective: To report 12-month safety and effectiveness outcomes of the Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH) and large-volume prostates.

Methods: One hundred and one men with moderate-to-severe BPH symptoms and prostate volumes of 80-150 cc underwent a robotic-assisted Aquablation procedure in a prospective multicenter international clinical trial. Functional and safety outcomes were assessed at 12 months postoperatively.

Results: Mean prostate volume was 107 cc (range 80-150). Mean operative time was 37 minutes and mean Aquablation resection time was 8 minutes. The average length of hospital stay following the procedure was 1.6 days. Mean International Prostate Symptom Score improved from 23.2 at baseline to 6.2 at 12 months (P <.0001). Mean International Prostate Symptom Score quality of life improved from 4.6 at baseline to 1.3 at 12-month follow-up (P <.0001). Significant improvements were seen in Qmax (12-month improvement of 12.5 cc/sec) and postvoid residual (drop of 171 cc in those with postvoid residual >100 at baseline). Antegrade ejaculation was maintained in 81% of sexually active men. No patient underwent a repeat procedure for BPH symptoms. There was a 2% de novo incontinence rate at 12 months, and 10 patients did require a transfusion postoperatively while 5 required take back fulgurations. At 12 months, prostate-specific antigen reduced from 7.1 ± 5.9 ng/mL at baseline to 4.4 ± 4.3 ng/mL.

Conclusion: The Aquablation procedure is demonstrated to be safe and effective in treating men with large prostates (80-150 cc) after 1 year of follow-up, with an acceptable complication rate and without a significant increase in procedure or resection time compared to smaller sized glands. ClinicalTrials.gov number, NCT03123250.
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http://dx.doi.org/10.1016/j.urology.2019.04.029DOI Listing
July 2019

Total Surface Area Influences Stone Free Outcomes in Shock Wave Lithotripsy for Distal Ureteral Calculi.

J Endourol 2019 08 13;33(8):661-666. Epub 2019 Apr 13.

Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.

Current American Urological Association guidelines recommend ureteroscopy (URS) as primary management of distal ureteral stones and shock wave lithotripsy (SWL) as a secondary option. Utilization of SWL in the management of nephrolithiasis in North America has decreased. We hypothesized that SWL continues to be an effective option in the management of distal ureteral calculi and studied data from our center in patients who received SWL for distal ureteral stones. A retrospective review was performed of 104 patients treated initially with SWL for distal ureteral calculi between 2011 and 2018 at this institution. The success rate of SWL was assessed through radiologic imaging and if subsequent procedures were required to render patients stone free. Operative note and chart review identified 104 patients who presented with distal ureteral stones and were treated with SWL as the initial form of management. Average patient age was 52.2 ± 15.3 years, average BMI was 27.4 ± 5.7, and average total axial stone surface area was 25.96 ± 14.32 mm. Of these patients, 78.8% ( = 82) were stone free following one SWL and required no subsequent procedures. Of these patients, 87.5% ( = 91) were stone free following a second SWL, and 87.5% ( = 91) were stone free following a secondary URS. After the initial SWL, residual stones were identified in 21.2% of patients ( = 22). Four patients, 3.8%, required a salvage URS following a failed second SWL to achieve stone-free status. One SWL procedure offers a stone-free rate (SFR) of 78.8% and after two SWLs an 87.5% SFR. Only 12.5% of patients undergoing SWL at our center required URS to achieve a stone-free status. SWL is an effective modality in the treatment of distal ureteral stones.
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http://dx.doi.org/10.1089/end.2019.0120DOI Listing
August 2019

Aquablation for benign prostatic hyperplasia in large prostates (80-150 mL): 6-month results from the WATER II trial.

BJU Int 2019 08 29;124(2):321-328. Epub 2019 Mar 29.

University of Montreal Hospital Center, Université de Montréal, Montreal, QC, Canada.

Objective: To present 6-month safety and effectiveness data from a multicentre prospective study of aquablation in men with lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH) with prostate volumes between 80 and 150 mL.

Methods: Between September and December 2017, 101 men with LUTSattributable to BPHwere prospectively enrolled at 16 centres in Canada and the USA.

Results: The mean prostate volume was 107 mL. The mean length of hospital stay after the aquablation procedure was 1.6 days (range: same day to 6 days). The primary safety endpoint (Clavien-Dindo grade 2 or higher or any grade 1 event resulting in persistent disability) at 3 months occurred in 45.5% of men, which met the study design goal of < 65% (P < 0.001). At 6 months, 22% of the patients had experienced a Clavien-Dindo grade 2, 14% a grade 3 and 5% a grade 4 adverse event. Bleeding complications requiring intervention and/or transfusion were recorded in eight patients prior to discharge and in six patients after discharge. The mean International Prostate Symptom Score improved from 23.2 ± 6.3 at baseline to 6.7 ± 5.1 at 3 months, meeting the study's primary efficacy endpoint goal (P < 0.001). The maximum urinary flow rate increased from 8.7 to 18.8 mL/s (P < 0.001) and post-void residual urine volume decreased from 131 at baseline to 47 at 6 months (P < 0.0001). At 6 months, prostate-specific antigen concentration reduced from 7.1 ± 5.9 ng/mL at baseline to 4.0 ± 3.9 ng/mL, a 44% reduction.

Conclusions: Aquablation is safe and effective in treating men with larger prostates (80-150 mL), without significant increase in procedure or resection time.
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http://dx.doi.org/10.1111/bju.14703DOI Listing
August 2019

Aquablation among novice users in Canada: A WATER II subpopulation analysis.

Can Urol Assoc J 2019 May 15;13(5):E113-E118. Epub 2018 Oct 15.

Division of Urology, University of Montreal Hospital Centre, Université de Montréal, Montreal, QC, Canada.

Introduction: Surgical management options for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) associated with prostates of small to moderate volume (<80 cc) are numerous; however, for men with enlarged prostates (>80 cc), many of these options are neither safe nor effective. Recently, Aquablation (PROCEPT BioRobotics, Inc., U.S.), a precise ultrasound-guided, robotically executed prostatic ablative procedure, has become available with U.S. Food and Drug Administration approval. Herein, we present three-month safety and efficacy data from the cohort of Canadian men included in the WATER II trial.

Methods: WATER II is a prospective clinical trial of the Aquablation system for the treatment of BPH in men with prostate volumes between 80 and 150 cc. Only patients from Canada were included for this analysis. At baseline, subjects completed International Prostate Symptom Score (IPSS), as well as several validated questionnaires, uroflowmetry and post-void residual volume measurements, and underwent standard laboratory blood assessment. These were repeated at one and three months post-Aquablation.

Results: A total of 19 subjects who met inclusion and exclusion criteria were enrolled at three Canadian academic sites. Mean pre-, one-month, and three-month post-treatment IPSS scores were 21.2±5.5, 9.9±6.9 (p<0.0001), and 5.0±4.5 (p<0.0001), respectively. Mean pre-, one-month, and three-month post-treatment maximum urinary flow rates (Qmax) were 6.6±3.1 ml/s, 19.5±6.1 ml/s (p<0.0001), and 23.1±9.2 ml/s (p<0.0001), respectively. The Clavien-Dindo grade 2 or higher event rate at three months was 31.6% (six events).

Conclusions: In this short-term, three-month analysis of Canadian men, Aquablation appears to provide a strong surgical alternative in patients with LUTS/BPH due to larger prostate volumes, with impressive functional outcomes, relatively short operative time and length of hospital stay, and acceptable complication and low transfusion rates.
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http://dx.doi.org/10.5489/cuaj.5501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520060PMC
May 2019

WATER II (80-150 mL) procedural outcomes.

BJU Int 2019 01 10;123(1):106-112. Epub 2018 Jun 10.

University of Montreal Hospital Centre, University of Montréal, Montreal, QC, Canada.

Objectives: To present early safety and feasibility data from a multicentre prospective study (WATER II) of aquablation in the treatment of symptomatic men with large-volume benign prostatic hyperplasia (BPH).

Methods: Between September and December 2017, 101 men with moderate-to-severe BPH symptoms and prostate volume of 80-150 mL underwent aquablation in a prospective multicentre international clinical trial. Baseline demographics and standardized postoperative management variables were carefully recorded in a central independently monitored database. Surgeons answered analogue scale questionnaires on intra-operative technical factors and postoperative management. Adverse events up to 1 month were adjudicated by an independent clinical events committee.

Results: The mean (range) prostate volume was 107 (80-150) mL. The mean (range) operating time was 37 (15-97) min and aquablation resection time was 8 (3-15) min. Adequate adenoma resection was achieved with a single pass in 34 patients and with additional passes in 67 patients (mean 1.8 treatment passes), all in a single operating session. Haemostasis was achieved using either a Foley balloon catheter placed in the bladder under traction (n = 98, mean duration 18 h) or direct tamponade using a balloon inflated in the prostate fossa (n = 3, mean duration 15 h). No patient required electrocautery for haemostasis at the time of the primary procedure. The mean length of stay after the procedure was 1.6 days (range same day to 6 days). The Clavien-Dindo grade ≥2 event rate observed at 1 month was 29.7%. Bleeding complications were recorded in 10 patients (9.9%) during the index procedure hospitalization prior to discharge, and included six (5.9%) peri-operative transfusions.

Conclusions: Aquablation is feasible and safe in treating men with men with large prostates (80-150 mL). The 6-month efficacy data are being accrued and will be presented in future publications (ClinicalTrials.gov number, NCT03123250).
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http://dx.doi.org/10.1111/bju.14360DOI Listing
January 2019

Percuflex Helical Ureteral Stents Significantly Reduce Patient Analgesic Requirements Compared to Control Stents.

J Endourol 2017 Dec 20;31(12):1321-1325. Epub 2017 Nov 20.

Department of Urologic Sciences, University of British Columbia , Vancouver, British Columbia.

Introduction And Objectives: Ureteral stent symptoms are experienced by the majority of patients with ureteral stents. No one stent or technology has shown a clear advantage. The Helical™ stent, a spirally cut stent made of proprietary Percuflex™ material, was designed to conform to the shape of the ureter and better accommodate patient movement. We prospectively sought to compare unscheduled visits, analgesic use, and pain scores in patients who received a Percuflex Helical ureteral stent following ureteroscopy compared to a historical control group.

Methods: Fifteen (n = 15) patients undergoing ureteroscopy for the treatment of kidney stones were consented for study. A Percuflex Helical ureteral stent was inserted after treating the urinary stone. The historical control group consisted of 30 patients, from a previous (ketorolac eluting) ureteral stent study utilizing the same protocol and clinical monitoring forms, who received a regular Percuflex ureteral stent. The control patients were matched by age and sex. The primary study outcome was to compare unscheduled visits. Secondary outcomes included comparison of Visual Pain Analog Scale (VPAS) scores and analgesic use between the two groups.

Results: There were no differences in the gender, age, BMI, or stone characteristics between groups. Both groups underwent retrograde ureteroscopy using holmium:YAG laser lithotripsy and stone fragmentation. There was a significant reduction in the amount of analgesics required in the Helical stent group (4.4 ± 7.99 mg morphine equivalents) compared to controls (16.75 ± 18.31 mg, p = 0.0035) to achieve similar VPAS scores. There was no difference in unscheduled visits (20%) or VPAS scores (13.84 ± 13.68 helical vs 14.29 ± 11.58 control, p = 0.7910) between groups.

Conclusions: Patients who received a Percuflex Helical ureteral stent required significantly fewer analgesics than those who received a Percuflex stent and both had equivalent pain scores.
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http://dx.doi.org/10.1089/end.2017.0349DOI Listing
December 2017

Complications, Re-Intervention Rates, and Natural History of Residual Stone Fragments After Percutaneous Nephrolithotomy.

J Endourol 2018 01 17;32(1):28-32. Epub 2017 Nov 17.

2 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada .

Introduction: The management of residual fragments (RFs) that persist after percutaneous nephrolithotomy (PCNL) has been poorly studied. Fragments have the potential to grow or cause symptoms. The aim of this study was to follow patients with fragments after PCNL to identify predictors of stone-related events (re-interventions and complications) after PCNL.

Patients And Methods: Data were retrospectively collected from patients who underwent surgery from 2008 to 2013 at our hospital. Patients with fragments of any size on postoperative day 1 computed tomography of the kidney, ureter, and bladder radiograph (CT-KUB) were included, and patients with planned secondary interventions were excluded. Subgroup analysis was performed on subjects with CT-plain X-ray to determine fragment growth or passage.

Results: Of the 658 patients who received a postoperative CT-KUB on day 1, 299 patients (45%) had fragments that were 1 mm or larger. From this, 263 patients met the study criteria and were included. The size of fragments, using a 4 mm cutoff, did not predict the passage of fragments (p = 0.173) or growth (p = 0.572). On multivariable logistic regression analysis, previous history of renal stones and size of fragment were found to be predictive for stone-related events (p = 0.002 and 0.027, respectively). Kaplan-Meier analysis identified patients with fragments >4 mm having a shorter survival time before the occurrence of stone-related events (p = 0.044).

Conclusions: The true stone-free rate was 55% after PCNL. However, 82.5% were stone free or had RFs 4 mm or less, which correlates with previous studies. Larger RFs had higher rates of stone-related events and shorter time to occurrence of stone-related events. The growth and spontaneous passage of RFs was independent of RF size, emphasizing the importance of obtaining a stone-free status after PCNL.
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http://dx.doi.org/10.1089/end.2017.0618DOI Listing
January 2018

Randomized Controlled Trial Comparing Three Different Modalities of Lithotrites for Intracorporeal Lithotripsy in Percutaneous Nephrolithotomy.

J Endourol 2017 11 3;31(11):1145-1151. Epub 2017 Nov 3.

1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana.

Purpose: To compare the efficiency (stone fragmentation and removal time) and complications of three models of intracorporeal lithotripters in percutaneous nephrolithotomy (PCNL).

Materials And Methods: Prospective, randomized controlled trial at nine centers in North America from 2009 to 2016. Patients were randomized to one of three lithotripter devices: the Cyberwand, a dual-probe ultrasonic device; the Swiss Lithoclast Select, a combination pneumatic and ultrasonic device; and the StoneBreaker, a portable pneumatic device powered by CO cartridges. Since the StoneBreaker lacks an ultrasonic component, it was used with the LUS-II ultrasonic lithotripter to allow fair comparison with combination devices.

Results: Two hundred seventy patients were enrolled, 69 were excluded after randomization. Two hundred one patients completed the study: 71 in the Cyberwand group, 66 in the Lithoclast Select group, and 64 in the StoneBreaker group. The baseline patient characteristics of the three groups were similar. Mean stone surface area was smaller in the StoneBreaker group at 407.8 mm vs 577.5 mm (Lithoclast Select) and 627.9 mm (Cyberwand). The stone clearance rate was slowest in the StoneBreaker group at 24.0 mm/min vs 28.9 mm/min and 32.3 mm/min in the Lithoclast Select and Cyberwand groups, respectively. After statistically adjusting for the smaller mean stone in the StoneBreaker group, there was no difference in the stone clearance rate among the three groups (p = 0.249). Secondary outcomes, including complications and stone-free rates, were similar between the groups.

Conclusions: The Cyberwand, Lithoclast Select, and the StoneBreaker lithotripters have similar adjusted stone clearance rates in PCNL for stones >2 cm. The safety and efficacy of these devices are comparable.
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http://dx.doi.org/10.1089/end.2017.0436DOI Listing
November 2017

CUA guideline on the evaluation and medical management of the kidney stone patient - 2016 update.

Can Urol Assoc J 2016 Nov-Dec;10(11-12):E347-E358. Epub 2016 Nov 10.

Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

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http://dx.doi.org/10.5489/cuaj.4218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234401PMC
November 2016

Benchtop and Initial Clinical Evaluation of the ShockPulse Stone Eliminator in Percutaneous Nephrolithotomy.

J Endourol 2017 02 6;31(2):191-197. Epub 2017 Jan 6.

1 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada .

Purpose: Standardized bench testing of the new ShockPulse™ intracorporeal lithotripter was performed against three commercially available lithotripsy systems to determine differences and nuances in performance.

Materials And Methods: The ShockPulse intracorporeal lithotripter was tested against the LUS-2™, CyberWand,™ and EMS LithoClast™ in a standardized bench setting using hard (Ultracal-30) and soft (plaster of Paris) stone phantoms. An in vitro kidney model was used to record the time needed to fragment stone samples into retrievable-sized pieces. The time needed to fully comminute and evacuate stone samples was also recorded. The efficacy of each device at various applied pressures was determined using a hands-free apparatus, which was used to apply 1.0, 1.5, and 2.0 pounds of fixed force.

Results: For hard and soft stones, the time needed to create retrievable fragments was similar among all systems (p = 0.585). The ShockPulse was significantly faster than the LUS-2 and LithoClast at fully fragmenting and evacuating stone samples (p = 0.046), while the CyberWand was significantly slower than all three systems at this task (p = 0.001). When fixed forces were applied to a large stone phantom, the ShockPulse and CyberWand were significantly faster than the LUS-2 and LithoClast (p < 0.0001). When groups of smaller stones were tested, the ShockPulse was significantly faster at 1.0 pound (p < 0.001) and 1.5 pounds (p < 0.002) of force. At 2.0 pounds, no differences were observed (p = 0.09).

Conclusions: The ShockPulse is equally as effective and, in some circumstances, more effective than the three commercially available devices against which it was tested in an in vitro setting.
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http://dx.doi.org/10.1089/end.2016.0664DOI Listing
February 2017

Significant differences in struvite and cystine stone frequency seen among Chinese nephrolithiasis patients living in North America compared to those living in China.

Transl Androl Urol 2016 Jun;5(3):375-80

1 Department of Urology, University of California, San Francisco, San Francisco, CA 94143, USA ; 2 Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Patumwan, Bangkok 10330, Thailand ; 3 Beijing Tsinghua Changgung Hospital, Beijing 102218, China ; 4 Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China ; 5 The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China ; 6 University of British Columbia, Vancouver V6T 1Z4, BC, Canada ; 7 Department of Surgery, University of California San Diego, San Diego, CA 92103, USA.

Background: Interracial disparities in nephrolithiasis prevalence have been reported, but the interplay between genetics and the environment for urinary stone disease risk factors is poorly understood. To examine how environment may alter genetic predisposition for stone formation, we established the International Chinese Consortium on Nephrolithiasis (ICCON) as a multi-institutional collaboration to examine patterns of nephrolithiasis presentation between Chinese patients living in different countries.

Methods: Chinese patients undergoing percutaneous nephrolithotomy (PCNL) at six participating institutions in China and North America over 4 years were reviewed retrospectively. Patient demographics and clinical data were compared between Chinese patients living in China and North America.

Results: A total of 806 patients were included, encompassing 721 Chinese patients living in China and 85 living in North America. Nephrolithiasis patients living in China were more likely to be male (67% vs. 56%, P=0.02), present at a younger age (48.6±15.0 vs. 55.0±13.0 years, P<0.01), and have a lower BMI (24.6±4.0 vs. 25.9±5.7, P=0.04) but were less likely to form struvite stones (5.5% vs. 14.1%, P<0.01). No cystine stone patients were seen in North American Chinese patients, whereas 1.8% of nephrolithiasis patients living in China presented with cystine stones. Similar rates of calcium-based and uric acid calculi as well as urinary pH were seen among both groups.

Conclusions: Significant differences exist between Chinese nephrolithiasis patients living in China compared to those living in North America, highlighting the importance of environmental factors in addition to genetics in modulating risk for urinary stone disease.
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http://dx.doi.org/10.21037/tau.2016.04.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893518PMC
June 2016

Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution.

Can Urol Assoc J 2015 Nov-Dec;9(11-12):E921-4. Epub 2015 Dec 14.

University of British Columbia, Vancouver, BC, Canada.

Introduction: Ureteral strictures are a significant cause of morbidity and mortality, resulting in potential kidney damage requiring several surgical procedures. Non-malignant causes include radiation, trauma from calculi impaction, pelvic surgery, or ureteroscopy (URS). We identified risk factors in our patients with ureteral strictures and the success of their treatment outcomes.

Methods: A retrospective chart review of 25 patients with 29 ureteral strictures was performed to determine the success of their treatment.

Results: Twenty-five (25) patients with 29 benign ureteral strictures were identified. Most cases (60%) were caused by impacted stones where the median stone size was 1.15 cm (0.37-1.8 cm). Intervention for stones prior to stricture development included shockwave lithotripsy, URS, and percutaneous nephrolithotomy. Five patients with strictures from impacted stones had ureteric complications during stone treatment including perforation +/- urinoma (n=3), fractured guidewire left in situ (n=1), and ureteric orifice resection (n=1). Other stricture etiologies included radiation (28%) and endometriosis (4%). Treatment modalities used included ureteroureterostomy (n=2), ureteral re-implant (n=3), urinary diversion (n=3), autotrasplant (n=1), laser endoureterotomy +/- balloon dilation (n=8), nephrectomy (n=2), balloon dilation +/- stent (n=3), ureterovesical junction (UVJ) resection + stent (n=1), chronic stent changes (n=4), or surveillance (n=3).

Conclusions: Our evaluation highlights important principles. Patients with complicated ureteroscopies or severely impacted calculi warrant close followup with imaging after stone treatment due to possibility of rapid renal deterioration from stricture formation. Radiation-induced strictures are difficult to manage, possibly requiring subsequent urinary diversion. Finally, endoscopic management of benign ureteral strictures via balloon dilation and laser endoureterotomy is an excellent choice in properly selected patients, with opportunity for subsequent salvage treatments if needed.
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http://dx.doi.org/10.5489/cuaj.3057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707921PMC
January 2016

Preparticipation Evaluation for Climbing Sports.

Wilderness Environ Med 2015 Dec;26(4 Suppl):S40-6

Division of Emergency Medicine, University of Utah Health Care, Salt Lake City, Utah (Drs Ng and McIntosh).

Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.
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http://dx.doi.org/10.1016/j.wem.2015.09.014DOI Listing
December 2015

A Single Dose of Intraoperative Antibiotics Is Sufficient to Prevent Urinary Tract Infection During Ureteroscopy.

J Endourol 2016 Jan 20;30(1):63-8. Epub 2015 Oct 20.

1 University of British Columbia , Vancouver, British Columbia, Canada .

Background: American Urology Association (AUA) Best Practice Guidelines for ureteroscopic stone treatment recommend antibiotic coverage for <24 hours following the procedure. The purpose of this study was to evaluate if the addition of postoperative antibiotics reduces urinary tract infections (UTIs) following ureteroscopic stone treatment beyond the recommended preoperative dose.

Methods: A retrospective review was performed of consecutive patients at two institutions, University of British Columbia and Massachusetts General Hospital, Harvard. All patients received a single dose of antibiotics before ureteroscopic stone treatment. A subset of patients was also given postoperative antibiotics. The rate of UTI was compared in patients receiving only preoperative antibiotics (group 1) vs those who received pre- and postoperative antibiotics (group 2).

Results: Eighty-one patients underwent ureteroscopy for renal calculi. Mean time to follow up was 42 ± 88 days. Eight (9.9%) patients in total (two from group 1 and six from group 2, p = 0.1457) developed UTIs postoperatively. In group 1, both patients presented with pyelonephritis (n = 2); those patients with infections in group 2 presented with urosepsis (n = 2) and cystitis (n = 2) and two patients had asymptomatic bacteriuria. Risk factors such as preoperative stenting, nephrostomy tubes, and foley catheters neither differed between groups nor did they predispose patients to postoperative infections.

Conclusions: The postoperative UTI rate in this study (9.9%) is consistent with previous reports. Our data suggest that a single preoperative dose of antibiotics is sufficient, and additional postoperative antibiotics do not decrease infection rates after ureteroscopic stone treatment. Risk for selection bias is a potential limitation.
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http://dx.doi.org/10.1089/end.2015.0511DOI Listing
January 2016

Preparticipation Evaluation for Climbing Sports.

Clin J Sport Med 2015 Sep;25(5):412-7

*Family and Sports Medicine, University of Utah Health Care, Salt Lake City, Utah; †Department of Emergency Medicine, University of Colorado School of Medicine; ‡Kaiser Permanente, Department of Emergency Medicine, University of Colorado; §Division of Emergency Medicine, University of Utah Health Care, Salt Lake City, Utah; ¶Arizona Sports Medicine Center, Mesa, Arizona; and ‖Central Maine Sports Medicine (a Clinical Division of CMMC), Evergreen Sports Medicine Fellowship, Lewiston, Maine.

Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.
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http://dx.doi.org/10.1097/JSM.0000000000000247DOI Listing
September 2015

Wilderness Medical Society practice guidelines for treatment of eye injuries and illnesses in the wilderness: 2014 update.

Wilderness Environ Med 2014 Dec;25(4 Suppl):S19-29

Denver Health Medical Center/University of Colorado School of Medicine, Denver, CO (Drs Paterson and Cushing).

A panel convened to develop an evidence-based set of guidelines for the recognition and treatment of eye injuries and illnesses that may occur in the wilderness. These guidelines are meant to serve as a tool to help wilderness providers accurately identify and subsequently treat or evacuate for a variety of ophthalmologic complaints. Recommendations are graded on the basis of the quality of their supporting evidence and the balance between risks and benefits according to criteria developed by the American College of Chest Physicians. This is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2012;23(4):325-336.
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http://dx.doi.org/10.1016/j.wem.2014.08.008DOI Listing
December 2014

Chikungunya, climate change, and human rights.

Health Hum Rights 2014 Jun 14;16(1):105-12. Epub 2014 Jun 14.

Staff Physician in Emergency Medicine for the Kaiser Permanente Group in Denver, Colorado, USA, and Assistant Professor in the Department of Emergency Medicine at the University of Colorado/Denver Health Medical Center.

Chikungunya is a re-emerging arbovirus that causes significant morbidity and some mortality. Global climate change leading to warmer temperatures and changes in rainfall patterns allow mosquito vectors to thrive at altitudes and at locations where they previously have not, ultimately leading to a spread of mosquito-borne diseases. While mutations to the chikungunya virus are responsible for some portion of the re-emergence, chikungunya epidemiology is closely tied with weather patterns in Southeast Asia. Extrapolation of this regional pattern, combined with known climate factors impacting the spread of malaria and dengue, summate to a dark picture of climate change and the spread of this disease from south Asia and Africa into Europe and North America. This review describes chikungunya and collates current data regarding its spread in which climate change plays an important part. We also examine human rights obligations of States and others to protect against this disease.
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June 2014

Percutaneous nephrolithotomy for removal of encrusted ureteral stents: a multicenter study.

J Endourol 2014 Oct 5;28(10):1188-91. Epub 2014 Jun 5.

1 Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon , New Hampshire.

Purpose: Encrusted ureteral stents are a challenging endourologic problem. We performed a multi-institutional review of percutaneous nephrolithotomy (PCNL) as primary treatment for encrusted stents.

Materials And Methods: We identified 36 patients who underwent PCNL for treatment of an encrusted stent. A retrospective review was performed to compile details of procedures and outcomes for these patients.

Results: In 36 patients, 38 renal units underwent PCNL for encrusted ureteral stents. The mean patient age was 47.1 years (±16.7), and the female:male ratio was 15:21. Mean stent indwelling time before removal was 28.2 months (±27.8). The reason for long indwelling time was reported in 25 cases; these reasons included "patient unaware stent needed to be removed" (17 cases), pregnancy (2 cases), other comorbidities (3 cases), and patient incarceration (3 cases). In 3 cases, the stent had become encrusted within 3 months of placement. Mean operative time was 162 minutes (±71). There were no major intraoperative complications, and no patients required blood transfusion. Litholapaxy was required for bladder coil encrustations in 22 cases (58%), and ureteroscopy with lithotripsy was required for encrustation of the ureteral portion of the stent in 13 cases (34.2%). Second look percutaneous procedures were required in 13 cases (34.2%). The stent was removed at the time of PCNL without need for concomitant or delayed ureteroscopy and/or cystolitholapaxy in 8 cases (21%). Ultimately, all stents were removed successfully. Patients were rendered stone free according to radiographs in 24 cases (63%).

Conclusions: In this multicenter review, PCNL is confirmed to be a safe and effective means of addressing the retained and encrusted ureteral stent. PCNL without ureteroscopy or litholapaxy was sufficient in a minority of cases (21%). Adjunctive endourologic modalities are often required, and the surgeon should anticipate the need for concomitant antegrade ureteroscopic laser lithotripsy and/or cystolitholapaxy. Although complete stent removal can be anticipated, residual fragments are not uncommon.
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http://dx.doi.org/10.1089/end.2014.0004DOI Listing
October 2014

AltitudeOmics: the integrative physiology of human acclimatization to hypobaric hypoxia and its retention upon reascent.

PLoS One 2014 21;9(3):e92191. Epub 2014 Mar 21.

Altitude Research Center, Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America.

An understanding of human responses to hypoxia is important for the health of millions of people worldwide who visit, live, or work in the hypoxic environment encountered at high altitudes. In spite of dozens of studies over the last 100 years, the basic mechanisms controlling acclimatization to hypoxia remain largely unknown. The AltitudeOmics project aimed to bridge this gap. Our goals were 1) to describe a phenotype for successful acclimatization and assess its retention and 2) use these findings as a foundation for companion mechanistic studies. Our approach was to characterize acclimatization by measuring changes in arterial oxygenation and hemoglobin concentration [Hb], acute mountain sickness (AMS), cognitive function, and exercise performance in 21 subjects as they acclimatized to 5260 m over 16 days. We then focused on the retention of acclimatization by having subjects reascend to 5260 m after either 7 (n = 14) or 21 (n = 7) days at 1525 m. At 16 days at 5260 m we observed: 1) increases in arterial oxygenation and [Hb] (compared to acute hypoxia: PaO2 rose 9±4 mmHg to 45±4 while PaCO2 dropped a further 6±3 mmHg to 21±3, and [Hb] rose 1.8±0.7 g/dL to 16±2 g/dL; 2) no AMS; 3) improved cognitive function; and 4) improved exercise performance by 8±8% (all changes p<0.01). Upon reascent, we observed retention of arterial oxygenation but not [Hb], protection from AMS, retention of exercise performance, less retention of cognitive function; and noted that some of these effects lasted for 21 days. Taken together, these findings reveal new information about retention of acclimatization, and can be used as a physiological foundation to explore the molecular mechanisms of acclimatization and its retention.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0092191PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962396PMC
January 2015

Intraocular pressure is not associated with acute mountain sickness.

High Alt Med Biol 2013 Dec;14(4):342-5

1 Department of Emergency Medicine, Denver Health Medical Center , Denver, Colorado.

Objective: Acute mountain sickness (AMS) is common at high altitude and may lead to high altitude cerebral edema (HACE) if not properly recognized. Previous studies have suggested that AMS is associated with increases in intracranial pressure (ICP). Increased ICP has been associated with increased intra-ocular pressure (IOP). This study was designed to determine the association between IOP and AMS.

Methods: Subjects were recruited from a convenience sample of travelers in the Khumbu region of Nepal, elevation 14,410 ft (4392 m). Study participation involved completion of a questionnaire to assess for AMS by the Lake Louise Score (LLS), followed by three IOP measurements in each eye. Investigators were blinded to the LLS. Subjects with a history of ocular surgery were excluded. Three IOP measurements per eye were made using an applanation tonometer (Tono-Pen XL(®), Reichart Technologies) and averaged across both eyes. Multivariable logistic regression analysis was used to estimate the association between IOP and AMS while adjusting for age, ascent or descent, and use of acetazolamide. IOP and blood O2 saturation were compared using a Spearman correlation coefficient.

Results: 161 subjects were enrolled with a median age of 36 (IQR: 29-45) years; 60% were male, 75% were ascending, and 64% were taking acetazolamide; additionally, 38%, (95% CI: 31%-47%) were diagnosed with AMS (LLS ≥3). The median IOP was 21 (IQR 18-24) mmHg. The logistic regression model demonstrated no association between IOP and AMS as measured by LLS (odds ratio [OR] 1.0, 95% CI: 0.9-1.1),age (OR 1.0, 95% CI: 0.9-1.0) or with use of acetazolamide (OR 1.4, 95% CI: 0.6-2.6). Ascent (OR 0.4, 95% CI: 0.2-0.9) was negatively associated with IOP but not significantly so. IOP and O2 saturation were not correlated (p=0.93).

Conclusions: IOP measured at high altitude is not associated with the diagnosis of AMS. Other approaches to diagnose AMS easily and accurately are needed.
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http://dx.doi.org/10.1089/ham.2013.1024DOI Listing
December 2013

Genitourinary tuberculosis masquerading as a ureteral calculus.

Can Urol Assoc J 2013 May-Jun;7(5-6):E363-6

University of British Columbia, Department of Urologic Sciences, Gordon & Leslie Diamond Health Care Centre, Vancouver, BC;

The genitourinary tract is a common extrapulmonary site of tuberculosis infection, yet remains a rare clinical entity in North America. We report the case of a 37-year-old man who presented for extracorporeal shock wave lithotripsy for a suspected ureteral stone on imaging. Further workup confirmed a diagnosis of genitourinary tuberculosis. Medical management was undertaken and, ultimately, nephrectomy performed. This case highlights the importance of maintaining a high index of clinical suspicion for genitourinary tuberculosis.
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http://dx.doi.org/10.5489/cuaj.1219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668412PMC
June 2013

Reply to Dr Jay Zimmermann's letter.

Wilderness Environ Med 2013 Jun 9;24(2):182-3. Epub 2013 Apr 9.

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http://dx.doi.org/10.1016/j.wem.2013.01.007DOI Listing
June 2013

A multicenter comparison of the safety and effectiveness of ureteroscopic laser lithotripsy in obese and normal weight patients.

J Endourol 2013 Jun;27(6):710-4

Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.

Objective: Surgical treatment of kidney stones in an obese patient (body mass index [BMI] >30 kg/m(2)) remains challenging as shockwave lithotripsy may not be an option due to weight limitations. We sought to determine the effectiveness of ureteroscopic laser lithotripsy in obese patients compared to nonobese controls.

Materials And Methods: Patients from 2004 to 2007 were retrospectively analyzed providing a group of 292 patients (163 obese, 76 overweight, 53 normal) who underwent ureteroscopic procedures for urolithiasis at four centers in the United States and Canada.

Results: The percentage of obese patients requiring flexible ureteroscopy (URS) (79%) was higher than in the other groups (P<0.0001). Flexible URS was associated with a lower stone-free rate (SFR) on multivariate analysis (P=0.034). There was no difference in SFRs of patients who required a ureteral access sheath, basket extraction, or received a postoperative stent. Complication rates did not differ between groups.

Conclusion: SFRs using ureteroscopic lithotripsy in obese and overweight populations are the same as in the normal weight patients. A flexible ureteroscope was associated with a decreased SFR, but this likely due to a more proximal stone location in these patients. Ureteroscopic laser lithotripsy is an effective and safe technique to treat urolithiasis in the overweight/obese patient.
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http://dx.doi.org/10.1089/end.2012.0605DOI Listing
June 2013
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