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Alotaibi T, Bjazevic J, Kim R, Gryn S, Sultan N, Dresser G, Razvi H. Allopurinol hypersensitivity syndrome: Raising awareness of an uncommon but potentially serious adverse event among kidney stone patients. Can Urol Assoc J 2024; 18:cuaj.8685. [PMID: 38319608 DOI: 10.5489/cuaj.8685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Allopurinol is a commonly prescribed agent in the urologic population for the prevention of urinary stones. Although generally well-tolerated, several serious potential side effects can occur with its use. Allopurinol hypersensitivity syndrome (AHS), in particular, is a relatively rare but potentially life-threatening complication. With the observed increase in urinary stone disease, especially those of uric acid composition, it is likely that the use of allopurinol will increase. Urologists play an important role in the assessment and medical management of patients with urinary stones, thus a greater awareness of the potential adverse events associated with allopurinol use, especially AHS, is important, as well as strategies that can minimize such risks. In this report we review the potential adverse effects of allopurinol. In addition, the results of a comprehensive review of the current literature on AHS will be presented, highlighting those patients at highest risk, reviewing the genetic susceptibility testing currently available, and providing guidance on best practices when allopurinol therapy is being considered.
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Affiliation(s)
- Tariq Alotaibi
- Division of Clinical Pharmacology, Department of Medicine, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Jennifer Bjazevic
- Division of Clinical Pharmacology, Department of Medicine, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Richard Kim
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Steven Gryn
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Nabil Sultan
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - George Dresser
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Hassan Razvi
- Division of Clinical Pharmacology, Department of Medicine, Schulich School of Medicine and Dentistry, London, ON, Canada
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Gabrigna Berto F, Wang P, McClure JA, Bjazevic J, Golomb D, Filler G, Diaz-Gonzalez de Ferris M, Welk B, Razvi H, Dave S. A population-based retrospective cohort study of surgical trends and outcomes of pediatric urolithiasis in Ontario, Canada (2002-2019). J Pediatr Urol 2023; 19:784-791. [PMID: 37739819 DOI: 10.1016/j.jpurol.2023.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/06/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION The worldwide incidence of pediatric urinary stone disease (PUSD) is increasing. However, there is no commensurate data on whether this translates to an increasing need for surgical intervention for PUSD, given the role of conservative management. OBJECTIVE We aimed to evaluate the trends and outcomes of clinically significant PUSD, using administrative databases to identify patients surgically treated for PUSD. STUDY DESIGN This retrospective population-based cohort study assessed the incidence and trends of surgically treated PUSD and outcomes in Ontario, Canada in patients <18 years of age who underwent their first PUSD procedure between 2002 and 2019 utilizing administrative databases held at the Institute of Clinical Evaluative Sciences (ICES). We assessed the incidence of surgically treated PUSD, demographics, initial surgical treatment and imaging modality, and risk factors for repeat intervention within 5 years. Statistical analyses summarized demographics, surgical trends, and logistic regression was used to identify risk factors for repeat surgical intervention. RESULTS We identified 1149 patients (mean age 11.3 years), with 59.6% older than 12 years. There was a decrease in the number of PUSD procedures performed per year that was close to statistical significance (p = 0.059) and a trend towards increased utilization of ureteroscopy (URS) compared with Shockwave Lithotripsy (SWL). In addition, there was a significant increase in the proportion of females surgically treated with PUSD (p = 0.001). In the 706 patients followed for 5 years, 17.7% underwent a repeat procedure within 6 months, while 20.4% underwent a repeat procedure from 6-months to 5 years. Renal stone location (OR 2.79, 95% confidence interval (CI) 1.62-4.80, p = 0.0002) and index SWL (OR 1.66, 95% CI 1.20-2.31, p = 0.0025) were risk factors for repeat surgical intervention within the first 6-months. There was an increasing utilization of ultrasound (US) compared to computerized tomography (CT) (p = 0.0008). DISCUSSION Despite the literature reporting increasing PUSD incidence, we observed a non-significant decrease in the number of surgical PUSD procedures performed. Exclusion of those treated conservatively may explain our results. The increase in the proportion of females treated reflects the narrowing gender gap in stone disease. A trend towards increased URS utilization was observed and re-intervention rates were similar to previous studies. CONCLUSION The overall rate of surgically treated PUSD did not show an increasing trend in Ontario, Canada from 2002 to 2019. URS was the most common surgical treatment modality, with a corresponding decline in SWL rates. PUSD was associated with a high surgical re-intervention rate within 6 months.
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Affiliation(s)
| | - Peter Wang
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Division of Pediatric Surgery and Division of Urology, Western University, London, Ontario, Canada
| | - J Andrew McClure
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Jennifer Bjazevic
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Dor Golomb
- Urology Department, Assuta Ashdod Hospital, Ashdod, Israel
| | - Guido Filler
- Department of Pediatrics, Division of Pediatric Nephrology, Western University, London, Ontario, Canada
| | | | - Blayne Welk
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Hassan Razvi
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Sumit Dave
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Division of Pediatric Surgery and Division of Urology, Western University, London, Ontario, Canada.
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Al KF, Joris BR, Daisley BA, Chmiel JA, Bjazevic J, Reid G, Gloor GB, Denstedt JD, Razvi H, Burton JP. Multi-site microbiota alteration is a hallmark of kidney stone formation. Microbiome 2023; 11:263. [PMID: 38007438 PMCID: PMC10675928 DOI: 10.1186/s40168-023-01703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 10/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Inquiry of microbiota involvement in kidney stone disease (KSD) has largely focussed on potential oxalate handling abilities by gut bacteria and the increased association with antibiotic exposure. By systematically comparing the gut, urinary, and oral microbiota of 83 stone formers (SF) and 30 healthy controls (HC), we provide a unified assessment of the bacterial contribution to KSD. RESULTS Amplicon and shotgun metagenomic sequencing approaches were consistent in identifying multi-site microbiota disturbances in SF relative to HC. Biomarker taxa, reduced taxonomic and functional diversity, functional replacement of core bioenergetic pathways with virulence-associated gene markers, and community network collapse defined SF, but differences between cohorts did not extend to oxalate metabolism. CONCLUSIONS We conclude that multi-site microbiota alteration is a hallmark of SF, and KSD treatment should consider microbial functional restoration and the avoidance of aberrant modulators such as poor diet and antibiotics where applicable to prevent stone recurrence. Video Abstract.
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Affiliation(s)
- Kait F Al
- Centre for Human Microbiome and Probiotic Research, Lawson Health Research Institute, London, ON, Canada
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON, Canada
| | - Benjamin R Joris
- Department of Biochemistry, The University of Western Ontario, London, ON, Canada
| | - Brendan A Daisley
- Molecular and Cellular Biology Department, University of Guelph, Guelph, ON, Canada
| | - John A Chmiel
- Centre for Human Microbiome and Probiotic Research, Lawson Health Research Institute, London, ON, Canada
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Gregor Reid
- Centre for Human Microbiome and Probiotic Research, Lawson Health Research Institute, London, ON, Canada
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON, Canada
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Gregory B Gloor
- Department of Biochemistry, The University of Western Ontario, London, ON, Canada
| | - John D Denstedt
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Jeremy P Burton
- Centre for Human Microbiome and Probiotic Research, Lawson Health Research Institute, London, ON, Canada.
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON, Canada.
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada.
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Chmiel JA, Stuivenberg GA, Wong J, Nott L, Burton J, Razvi H, Bjazevic J. Predictive modelling of urinary stone composition using machine learning and clinical data: implications for treatment strategies and pathophysiological insights. J Endourol 2023. [PMID: 37975292 DOI: 10.1089/end.2023.0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Preventative strategies and surgical treatment for urolithiasis depend on stone composition. However, stone composition is often unknown until the stone is passed or surgically managed. Given that stone composition likely reflects the physiological parameters during its formation, we used clinical data from stone formers to predict stone composition. MATERIAL AND METHODS Stone composition, 24-hour urine, serum biochemistry, patient demographic and medical history were prospectively collected from 777 kidney stone patients. Data were used to train gradient boosted machine and logistic regression models to distinguish calcium vs non-calcium, calcium oxalate monohydrate vs dihydrate, and calcium oxalate vs calcium phosphate vs uric acid stone types. Model performance was evaluated using kappa score and the influence of each predictor variable was assessed. RESULTS The calcium vs non-calcium model successfully differentiated stone types with a kappa of 0.5231. The most influential predictors were 24-hour urine calcium, blood urate and phosphate. The calcium oxalate monohydrate vs dihydrate model is the first of its kind and could discriminate stone types with a kappa of 0.2042. The key predictors were 24-hour urine urea, calcium, and oxalate. The multiclass model had a kappa of 0.3023 and the top predictors were age, and 24-hour urine calcium and creatinine. CONCLUSIONS Clinical data can be leveraged with machine learning algorithms to predict stone composition, which may help urologists determine stone type and guide their management plan before stone treatment. Investigating the most influential predictors of each classifier may improve the understanding of key clinical features of urolithiasis and shed light on the pathophysiology.
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Affiliation(s)
- John Antonio Chmiel
- Western University, 6221, Microbiology & Immunology, 1151 Richmond St, London, Ontario, Canada, N6A 3K7;
| | - Gerrit Alojzi Stuivenberg
- Western University, 6221, Microbiology & Immunology, 1151 Richmond Street, London, Ontario, Canada, N6A 3K7;
| | - Jennifer Wong
- Western University, 6221, Division of Urology, Department of Surgery, London, Ontario, Canada;
| | - Linda Nott
- University of Western Ontario, 6221, Urology, Urology, St. Joseph's Hospital, St. Joseph's Health Care London, 268 Grosvenor Street, London, Ontario, Canada, N6A 3K7;
| | | | - Hassan Razvi
- Western University, Urology, London, Ontario, Canada;
| | - Jennifer Bjazevic
- Western University, Urology, Room B4-660, 268 Grosvenor Street, London, Ontario, Canada, N6A 4V2;
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Filler G, Dave S, Ritter V, Ross S, Viprakasit D, Hatch JE, Bjazevic J, Burton J, Gilleskie D, Gilliland J, Lin FC, Jain N, McClure JA, Razvi H, Bhayana V, Wang P, Coulson S, Sultan N, Denstedt J, Fearrington L, Diaz-Gonzalez de Ferris ME. In focus: perplexing increase of urinary stone disease in children, adolescent and young adult women and its economic impact. Front Med (Lausanne) 2023; 10:1272900. [PMID: 37937142 PMCID: PMC10626457 DOI: 10.3389/fmed.2023.1272900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Background Urinary stone disease (USD) historically has affected older men, but studies suggest recent increases in women, leading to a near identical sex incidence ratio. USD incidence has doubled every 10 years, with disproportionate increases amongst children, adolescent, and young adult (AYA) women. USD stone composition in women is frequently apatite (calcium phosphate), which forms in a higher urine pH, low urinary citrate, and an abundance of urinary uric acid, while men produce more calcium oxalate stones. The reasons for this epidemiological trend are unknown. Methods This perspective presents the extent of USD with data from a Canadian Province and a North American institution, explanations for these findings and offers potential solutions to decrease this trend. We describe the economic impact of USD. Findings There was a significant increase of 46% in overall surgical interventions for USD in Ontario. The incidence rose from 47.0/100,000 in 2002 to 68.7/100,000 population in 2016. In a single United States institution, the overall USD annual unique patient count rose from 10,612 to 17,706 from 2015 to 2019, and the proportion of women with USD was much higher than expected. In the 10-17-year-old patients, 50.1% were girls; with 57.5% in the 18-34 age group and 53.6% in the 35-44 age group. The roles of obesity, diet, hormones, environmental factors, infections, and antibiotics, as well as the economic impact, are discussed. Interpretation We confirm the significant increase in USD among women. We offer potential explanations for this sex disparity, including microbiological and pathophysiological aspects. We also outline innovative solutions - that may require steps beyond typical preventive and treatment recommendations.
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Affiliation(s)
- Guido Filler
- Department of Paediatrics, Western University, London, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Sumit Dave
- Department of Surgery, Western University, London, ON, Canada
| | - Victor Ritter
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sherry Ross
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Davis Viprakasit
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Joseph E. Hatch
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Jeremy Burton
- Department of Surgery, Western University, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Donna Gilleskie
- Department of Economics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason Gilliland
- Department of Geography, Western University, London, ON, Canada
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nina Jain
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Hassan Razvi
- Department of Surgery, Western University, London, ON, Canada
| | - Vipin Bhayana
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Peter Wang
- Department of Surgery, Western University, London, ON, Canada
| | - Sherry Coulson
- Department of Paediatrics, Western University, London, ON, Canada
| | - Nabil Sultan
- Department of Medicine, Western University, London, ON, Canada
| | - John Denstedt
- Department of Surgery, Western University, London, ON, Canada
| | - Loretta Fearrington
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Chmiel JA, Stuivenberg GA, Al KF, Akouris PP, Razvi H, Burton JP, Bjazevic J. Vitamins as regulators of calcium-containing kidney stones - new perspectives on the role of the gut microbiome. Nat Rev Urol 2023; 20:615-637. [PMID: 37161031 PMCID: PMC10169205 DOI: 10.1038/s41585-023-00768-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/11/2023]
Abstract
Calcium-based kidney stone disease is a highly prevalent and morbid condition, with an often complicated and multifactorial aetiology. An abundance of research on the role of specific vitamins (B6, C and D) in stone formation exists, but no consensus has been reached on how these vitamins influence stone disease. As a consequence of emerging research on the role of the gut microbiota in urolithiasis, previous notions on the contribution of these vitamins to urolithiasis are being reconsidered in the field, and investigation into previously overlooked vitamins (A, E and K) was expanded. Understanding how the microbiota influences host vitamin regulation could help to determine the role of vitamins in stone disease.
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Affiliation(s)
- John A Chmiel
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotic Research, London, Ontario, Canada
| | - Gerrit A Stuivenberg
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotic Research, London, Ontario, Canada
| | - Kait F Al
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotic Research, London, Ontario, Canada
| | - Polycronis P Akouris
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotic Research, London, Ontario, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Jeremy P Burton
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotic Research, London, Ontario, Canada
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.
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Chmiel JA, Carr C, Stuivenberg GA, Venema R, Chanyi RM, Al KF, Giguere D, Say H, Akouris PP, Domínguez Romero SA, Kwong A, Tai V, Koval SF, Razvi H, Bjazevic J, Burton JP. Corrigendum: New perspectives on an old grouping: the genomic and phenotypic variability of Oxalobacter formigenes and the implications for calcium oxalate stone prevention. Front Microbiol 2023; 14:1231746. [PMID: 37378284 PMCID: PMC10291882 DOI: 10.3389/fmicb.2023.1231746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fmicb.2022.1011102.].
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Affiliation(s)
- John A. Chmiel
- Department of Microbiology and Immunology, Western University, London, ON, Canada
- Canadian Centre for Human Microbiome and Probiotics Research, London, ON, Canada
| | - Charles Carr
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Gerrit A. Stuivenberg
- Department of Microbiology and Immunology, Western University, London, ON, Canada
- Canadian Centre for Human Microbiome and Probiotics Research, London, ON, Canada
| | - Robertson Venema
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Ryan M. Chanyi
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Kait F. Al
- Department of Microbiology and Immunology, Western University, London, ON, Canada
- Canadian Centre for Human Microbiome and Probiotics Research, London, ON, Canada
| | - Daniel Giguere
- Department of Biology, Western University, London, ON, Canada
| | - Henry Say
- Department of Biology, Western University, London, ON, Canada
| | - Polycronis P. Akouris
- Department of Microbiology and Immunology, Western University, London, ON, Canada
- Canadian Centre for Human Microbiome and Probiotics Research, London, ON, Canada
| | | | - Aaron Kwong
- Department of Medicine, Western University, London, ON, Canada
| | - Vera Tai
- Department of Biology, Western University, London, ON, Canada
| | - Susan F. Koval
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Jeremy P. Burton
- Department of Microbiology and Immunology, Western University, London, ON, Canada
- Canadian Centre for Human Microbiome and Probiotics Research, London, ON, Canada
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
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Wallace B, Chmiel JA, Al KF, Bjazevic J, Burton JP, Goldberg HA, Razvi H. The Role of Urinary Modulators in the Development of Infectious Kidney Stones. J Endourol 2023; 37:358-366. [PMID: 36562270 DOI: 10.1089/end.2022.0458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: The pathogenesis of infectious kidney stones is poorly understood. Bacteria have been implicated in promoting infectious stones via urease production; however, there is mounting evidence indicating the relationship is more complex. The aim of our study was to characterize suspected biotic and abiotic extrinsic factors that may modulate the formation of infectious stones. Materials and Methods: A high-throughput experimental model with Griffith's artificial urine was used to test a wide variety of urinary modulators and cytoplasmic enzymes present in crude cell-free extracts (CFEs) from bacterial strains to investigate how they impact struvite and calcium (Ca) phosphate crystal production. Crystal formation was evaluated with spectrophotometry and growth curve analysis. Light microscopy and scanning electron microscopy/X-ray diffraction was used for crystal structure and composition identification. Results: The acidic urinary modulators used in this study prevented crystal formation, whereas osteopontin had a significant inhibitory effect. Addition of CFEs from Proteus mirabilis 175A and 177A resulted in Ca phosphate and struvite crystals. Of interest, Klebsiella pneumoniae and Klebsiella oxytoca produced crystals including Ca phosphate and Ca oxalate, respectively. Pseudomonas aeruginosa had no urease production detected and produced Ca phosphate crystals. Discussion: Urinary modulators can have a wide variety of effects on infectious stone formation and the role of pH is important but does not guarantee robust crystal formation. Bacterial strains can produce Ca oxalate, Ca phosphate, and struvite stones with and without urease activity. Conclusion: Various urinary modulators appear to influence the process and are worthy of further evaluation as a potential therapeutic strategy to prevent infection-related urinary stone formation. Stones formed from urinary tract infections may be a result of multiple encoded metabolic pathways and discovering these would improve our understanding of the stone-bacterial relationship.
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Affiliation(s)
- Brendan Wallace
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - John A Chmiel
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Kait F Al
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Jeremy P Burton
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Harvey A Goldberg
- Department of Dentistry and Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Chmiel J, Kiattiburut W, Kwong A, Prabhu P, Razvi H, Luyt L, Burton J, Bjazevic J. The development of a hollow three-dimensional kidney spheroid model for the study of calcium-containing crystal formation. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00441-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Akouris PP, Chmiel JA, Stuivenberg GA, Kiattiburut W, Bjazevic J, Razvi H, Grohe B, Goldberg HA, Burton JP, Al KF. Osteopontin phosphopeptide mitigates calcium oxalate stone formation in a Drosophila melanogaster model. Urolithiasis 2022; 51:19. [PMID: 36547746 DOI: 10.1007/s00240-022-01395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Kidney stone disease affects nearly one in ten individuals and places a significant economic strain on global healthcare systems. Despite the high frequency of stones within the population, effective preventative strategies are lacking and disease prevalence continues to rise. Osteopontin (OPN) is a urinary protein that can inhibit the formation of renal calculi in vitro. However, the efficacy of OPN in vivo has yet to be determined. Using an established Drosophila melanogaster model of calcium oxalate urolithiasis, we demonstrated that a 16-residue synthetic OPN phosphopeptide effectively reduced stone burden in vivo. Oral supplementation with this peptide altered crystal morphology of calcium oxalate monohydrate (COM) in a similar manner to previous in vitro studies, and the presence of the OPN phosphopeptide during COM formation and adhesion significantly reduced crystal attachment to mammalian kidney cells. Altogether, this study is the first to show that an OPN phosphopeptide can directly mitigate calcium oxalate urolithiasis formation in vivo by modulating crystal morphology. These findings suggest that OPN supplementation is a promising therapeutic approach and may be clinically useful in the management of urolithiasis in humans.
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Affiliation(s)
- Polycronis P Akouris
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - John A Chmiel
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Gerrit A Stuivenberg
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Wongsakorn Kiattiburut
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Bernd Grohe
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
| | - Harvey A Goldberg
- Department of Biochemistry, Western University, London, ON, Canada
- School of Dentistry, Western University, London, ON, Canada
| | - Jeremy P Burton
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Kait F Al
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada.
- Department of Microbiology and Immunology, Western University, London, ON, Canada.
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Chmiel JA, Carr C, Stuivenberg GA, Venema R, Chanyi RM, Al KF, Giguere D, Say H, Akouris PP, Domínguez Romero SA, Kwong A, Tai V, Koval SF, Razvi H, Bjazevic J, Burton JP. New perspectives on an old grouping: The genomic and phenotypic variability of Oxalobacter formigenes and the implications for calcium oxalate stone prevention. Front Microbiol 2022; 13:1011102. [PMID: 36620050 PMCID: PMC9812493 DOI: 10.3389/fmicb.2022.1011102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
Oxalobacter formigenes is a unique bacterium with the ability to metabolize oxalate as a primary carbon source. Most kidney stones in humans are composed of calcium and oxalate. Therefore, supplementation with an oxalate-degrading bacterium may reduce stone burden in patients suffering from recurrent calcium oxalate-based urolithiasis. Strains of O. formigenes are divided into two groups: group I and group II. However, the differences between strains from each group remain unclear and elucidating these distinctions will provide a better understanding of their physiology and potential clinical applications. Here, genomes from multiple O. formigenes strains underwent whole genome sequencing followed by phylogenetic and functional analyses. Genetic differences suggest that the O. formigenes taxon should be divided into an additional three species: Oxalobacter aliiformigenes sp. nov, Oxalobacter paeniformigenes sp. nov, and Oxalobacter paraformigenes sp. nov. Despite the similarities in the oxalyl-CoA gene (oxc), which is essential for oxalate degradation, these strains have multiple unique genetic features that may be potential exploited for clinical use. Further investigation into the growth of these strains in a simulated fecal environment revealed that O. aliiformigenes strains are capable of thriving within the human gut microbiota. O. aliiformigenes may be a better therapeutic candidate than current group I strains (retaining the name O. formigenes), which have been previously tested and shown to be ineffective as an oral supplement to mitigate stone disease. By performing genomic analyses and identifying these novel characteristics, Oxalobacter strains better suited to mitigation of calcium oxalate-based urolithiasis may be identified in the future.
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Affiliation(s)
- John A. Chmiel
- Department of Microbiology and Immunology, Western University, London, ON, Canada,Canadian Centre for Human Microbiome and Probiotics Research, London, ON, Canada
| | - Charles Carr
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Gerrit A. Stuivenberg
- Department of Microbiology and Immunology, Western University, London, ON, Canada,Canadian Centre for Human Microbiome and Probiotics Research, London, ON, Canada
| | - Robertson Venema
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Ryan M. Chanyi
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Kait F. Al
- Department of Microbiology and Immunology, Western University, London, ON, Canada,Canadian Centre for Human Microbiome and Probiotics Research, London, ON, Canada
| | - Daniel Giguere
- Department of Biology, Western University, London, ON, Canada
| | - Henry Say
- Department of Biology, Western University, London, ON, Canada
| | - Polycronis P. Akouris
- Department of Microbiology and Immunology, Western University, London, ON, Canada,Canadian Centre for Human Microbiome and Probiotics Research, London, ON, Canada
| | | | - Aaron Kwong
- Department of Medicine, Western University, London, ON, Canada
| | - Vera Tai
- Department of Biology, Western University, London, ON, Canada
| | - Susan F. Koval
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Jeremy P. Burton
- Department of Microbiology and Immunology, Western University, London, ON, Canada,Canadian Centre for Human Microbiome and Probiotics Research, London, ON, Canada,Division of Urology, Department of Surgery, Western University, London, ON, Canada,*Correspondence: Jeremy P. Burton,
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12
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Razvi H. The CUASF: Almost 50 and going strong! Can Urol Assoc J 2022; 16:154. [PMID: 35623006 DOI: 10.5489/cuaj.7946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Cepek J, Wilson C, Denstedt JD, Stern N, Razvi H, Bjazevic J, Dave S, Wang P. Portable Endoscopic Simulator for Urological Training: A Face/Content and Construct Validity Study. J Endourol 2022; 36:1495-1501. [PMID: 35546282 DOI: 10.1089/end.2022.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mastering a surgical skill requires experience and repetition, yet opportunities for surgical trainees to gain real experience is variable and limited by case load. Surgical simulators have emerged in an attempt to overcome these limitations. However, the few currently available skills simulators for flexible endoscopy are costly, have limited accessibility and versatility, lack portability, and require dedicated time for practice. The use of a portable skills simulator to teach flexible endoscopy may provide a feasible alternative. This study introduces a novel, low-cost, portable, endoscopic simulation system for training basic endoscopic skills. Using custom software, the simulator presents a virtual environment featuring 3D models of anatomy, endoscopes, and endoscopic tools. The virtual endoscope and its tools are directly controlled in the simulation by motion input from a custom-manufactured portable endoscopic controller that communicates data via a Bluetooth interface. This two-part study presents proof of concept and initial pilot data examining the face/content validity and preliminary construct validity of the portable endoscopic simulator. In part one, experts (n = 2) and novices (n = 6) provided ratings of fidelity and utility as a training tool. In part two, experts (n = 4) and novices (n = 4) completed 10 simulated sequential basic endoscopic tasks and time to completion was assessed. Findings indicate that the simulator has good utility as a training tool, but some features require modification to be more realistic. Further, both novices and experts improved on the task with repeated measurements (p < .001), but there were no significant differences between experts and novices in time to completion. Although more robust validation is required, this simulator appears promising as a feasible and cost-effective tool for providing simulation training on basic endoscopic skills.
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Affiliation(s)
- Jeremy Cepek
- Western University Schulich School of Medicine & Dentistry, 70384, London, Ontario, Canada;
| | - Claire Wilson
- London Health Sciences Centre Children's Hospital, 10000, 800 Commissioners Rd., London, Ontario, Canada, N6A 5W9;
| | - John D Denstedt
- UWO, 6221, st Josephs hospital, London, Ontario, Canada, N6A 3K7;
| | - Noah Stern
- Western University Schulich School of Medicine & Dentistry, 70384, London, Ontario, Canada;
| | - Hassan Razvi
- Western University Schulich School of Medicine & Dentistry, 70384, London, Ontario, Canada;
| | - Jennifer Bjazevic
- Western University Schulich School of Medicine & Dentistry, 70384, London, Ontario, Canada;
| | - Sumit Dave
- Western University Schulich School of Medicine & Dentistry, 70384, London, Ontario, Canada;
| | - Peter Wang
- London Health Sciences Centre, 10033, Surgery, 800 Commissioners Road East, B1-147, London, Ontario, Canada, N6A 5W9.,Ontario, Canada;
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14
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Chmiel J, Venema R, Carr C, Al K, Chanyi R, Domínguez Romero SA, Stuivenberg G, Razvi H, Bjazevic J, Burton J. MP05-16 NEW PERSPECTIVES ON AN OLD GROUPING: THE GENOMIC AND PHENOTYPIC DIFFERENCES OF
OXALOBACTER FORMIGENES. J Urol 2022. [DOI: 10.1097/ju.0000000000002522.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Touma NJ, Leveridge MJ, Beiko D, Rowe N, Warren J, Watterson J, Blais AS, Wilson JWL, Morales A, Razvi H, Chin JLK, MacNeily AE. QUEST at 25: An enduring innovation in Canadian urology. Can Urol Assoc J 2022; 16:79-80. [PMID: 35358408 DOI: 10.5489/cuaj.7855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Naji J Touma
- Department of Urology, Queen's University, Kingston, ON, Canada
| | | | - Darren Beiko
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Neal Rowe
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Jeff Warren
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - James Watterson
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Anne-Sophie Blais
- Division of Urology, Department of Surgery CHU de Québec - Université Laval, Quebec, QC, Canada
| | | | - Alvaro Morales
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Hassan Razvi
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Joseph L K Chin
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Andrew E MacNeily
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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16
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Razvi H. The halfway mark in our five-year strategic plan: How are we doing? Can Urol Assoc J 2022; 16:83-84. [PMID: 35358409 DOI: 10.5489/cuaj.7840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Bhojani N, Bjazevic J, Wallace B, Lee L, Kaler KS, Dion M, Cowan A, Sultan N, Chew BH, Razvi H. Update – 2022 Canadian Urological Association guideline: Evaluation and medical management of the kidney stone patient. Can Urol Assoc J 2022; 16:175-188. [PMID: 35623003 PMCID: PMC9245965 DOI: 10.5489/cuaj.7872] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Naeem Bhojani
- Division of Urology, University of Montreal, Montreal, QC, Canada
| | - Jennifer Bjazevic
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Brendan Wallace
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Linda Lee
- Division of Urology, Department of Surgery, Vancouver Island Health Authority, Victoria, BC, Canada
| | - Kamaljot S. Kaler
- Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Marie Dion
- Niagara Health, St. Catherine’s, ON, Canada
| | - Andrea Cowan
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Nabil Sultan
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ben H. Chew
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hassan Razvi
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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18
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Chmiel J, Venema R, Carr C, Al K, Chanyi R, Ari Domínguez Romero S, Stuivenberg G, Razvi H, Bjazevic J, Burton J. New perspectives on an old grouping: The genomic and phenotypic differences of Oxalobacter formigenes. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01000-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Gabrigna Berto F, Mcclure A, Wang P, Bjazevic J, Golomb D, Filler G, Welk B, Razvi H, Dave S. Secular trends in pediatric urolithiasis surgical incidence and management in Ontario, Canada: A population based retrospective cohort study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00856-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Razvi H. Au revoir Zoom, bonjour Charlottetown! Can Urol Assoc J 2022; 15:E384-E385. [PMID: 35099379 DOI: 10.5489/cuaj.7535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Razvi H. A shout-out to our unsung heroes! Can Urol Assoc J 2022; 16:11. [DOI: 10.5489/cuaj.7764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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Bouhadana D, Nguyen DD, Raizenne B, Schwarcz J, Gordon H, Chughtai B, Elterman DS, Lavallée LT, Martin P, McAlpine K, Paterson R, Razvi H, Zorn KC, Bhojani N. Evaluating the acceptability of an online patient decision aid for the surgical management of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Can Urol Assoc J 2021; 15:247-254. [PMID: 34895444 DOI: 10.5489/cuaj.7492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The growing number of surgical options available to treat benign prostatic hyperplasia (BPH), may overwhelm patients and urologists when deciding on an optimal treatment. Therefore, we developed an online patient decision aid (PtDA) that includes all guideline-approved surgical modalities. The objective of this study was to assess the acceptability of the PtDA among former BPH surgery patients and urologists that treat BPH surgically. METHODS The International Patient Decision Aids Standards were used to develop a PtDA that includes monopolar transurethral resection of the prostate (TURP), bipolar TURP, GreenLight photovaporization, endoscopic enucleation of the prostate, Rezum, Urolift, Aquablation, open retropubic prostatectomy, and robotic simple prostatectomy as management options. Eleven urologists that regularly treat BPH and 19 patients who received BPH surgery were recruited. Alpha-testing was performed using a validated acceptability scoring system. RESULTS For all sections of the PtDA, most urologists agreed that the language used was easy to follow (91.9%), that the amount of information provided was adequate (63.6%), that the length of the PtDA was appropriate (63.6%), and that the outcomes reported were correct (81.8%). All 19 patient participants agreed that the language used was easy to follow, and most found that the amount of information provided was adequate (84.2%), that the length of the PtDA was appropriate (84.2%), and that the outcomes reported were well-explained (89.5%). CONCLUSIONS Our PtDA was found to be acceptable among urologists and patients. These results demonstrate that most of the participants either recommend the use of this tool or plan to incorporate it in their clinical practice.
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Affiliation(s)
- David Bouhadana
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Brendan Raizenne
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Harvey Gordon
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, United States
| | - Dean S Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Luke T Lavallée
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | | | - Kristen McAlpine
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Paterson
- Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
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23
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Chmiel JA, Stuivenberg GA, Alathel A, Gorla J, Grohe B, Razvi H, Burton JP, Bjazevic J. High-Throughput in vitro Gel-Based Plate Assay to Screen for Calcium Oxalate Stone Inhibitors. Urol Int 2021; 106:616-622. [PMID: 34883484 DOI: 10.1159/000519842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Kidney stones are a common medical condition that is increasing in prevalence worldwide. Approximately, ∼80% of urinary calculi are composed of calcium oxalate (CaOx). There is a growing interest toward identifying therapeutic compounds that can inhibit the formation of CaOx crystals. However, some chemicals (e.g., antibiotics and bacterial metabolites) may directly promote crystallization. Current knowledge is limited regarding crystal promoters and inhibitors. Thus, we have developed an in vitro gel-based diffusion model to screen for substances that directly influence CaOx crystal formation. MATERIALS AND METHODS We used double diffusion of sodium oxalate and calcium chloride-loaded paper disks along an agar medium to facilitate the controlled formation of monohydrate and dihydrate CaOx crystals. A third disk was used for the perpendicular diffusion of a test substance to assess its influence on CaOx crystal formation. RESULTS We confirmed that citrates and magnesium are effective inhibitors of CaOx crystals. We also demonstrated that 2 strains of uropathogenic Escherichia coli are able to promote crystal formation. While the other tested uropathogens and most antibiotics did not change crystal formation, ampicillin was able to reduce crystallization. CONCLUSION We have developed an inexpensive and high-throughput model to evaluate substances that influence CaOx crystallization.
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Affiliation(s)
- John A Chmiel
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada.,Lawson Research Health Research Institute, London, Ontario, Canada
| | - Gerrit A Stuivenberg
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada.,Lawson Research Health Research Institute, London, Ontario, Canada
| | - Abdulaziz Alathel
- Division of Urology, Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jaswanth Gorla
- Lawson Research Health Research Institute, London, Ontario, Canada
| | - Bernd Grohe
- Lawson Research Health Research Institute, London, Ontario, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Jeremy P Burton
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada.,Lawson Research Health Research Institute, London, Ontario, Canada.,Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
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24
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Razvi H. CUA and advocacy. Can Urol Assoc J 2021; 15:372. [PMID: 34847341 DOI: 10.5489/cuaj.7694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Razvi H. L'AUC et la défense des intérêts. Can Urol Assoc J 2021; 15:E622. [PMID: 34847352 DOI: 10.5489/cuaj.7713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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26
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Golomb D, Dave S, Berto FG, McClure JA, Welk B, Wang P, Bjazevic J, Razvi H. A population-based retrospective cohort study analyzing contemporary trends in the surgical management of urinary stone disease in adults. Can Urol Assoc J 2021; 16:112-118. [PMID: 34812726 DOI: 10.5489/cuaj.7474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to review the trends and incidence of surgical intervention for adults with upper urinary tract stones in Ontario, Canada, and to hypothesize potential causes for the observed changes. METHODS We carried out a retrospective, population-based cohort study using administrative databases held at the Institute of Clinical Evaluative Sciences (IC/ES) to identify all adults (≥18 years) who underwent surgical treatment for urolithiasis, defined by records using a combination of both hospital and physician billing from 2002-2019. Descriptive statistics were used to summarize baseline patient demographics, and surgical trends were analyzed using the Cochrane-Armitage test for trend. RESULTS From 2002-2019, 140 263 patients were treated surgically for urolithiasis. During this time period, the total number of surgically treated stone disease increased by 80.5%. By type of procedure, percutaneous nephrolithotomy (PCNL) increased by 187% and ureteroscopy (URS) increased by 158%, while the number of shockwave lithotripsy (SWL) declined by 31.4%. The adult population in Ontario in the years evaluated grew by 24.4%. The number of surgical procedures per 100 000 people over this time grew by 45.3%. For every 1% increase in the population, there was a 2.6% rise in stone-related surgical procedures. CONCLUSIONS The number of stone-related surgical procedures performed rose significantly and cannot be accounted for by population growth alone. This rise was proportionally larger in the female population, further supporting a narrowing of the gender gap in urinary stone disease. The reasons for the increase are likely multifactorial and may imply an increasing incidence of surgically treated stone disease. The change in the proportion of URS and SWL performed may demonstrate a continued shift in surgical preference or may be reflective of resource limitations and availability. The increase in PCNL volumes may also suggest a greater complexity of cases. These findings should be considered for future resource planning and require further study.
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Affiliation(s)
- Dor Golomb
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sumit Dave
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Fernanda Gabrigna Berto
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - J Andrew McClure
- Department of Surgery, Schulich School of Medicine and Dentistry London Health Sciences Centre, London, ON, Canada
| | - Blayne Welk
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Peter Wang
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jennifer Bjazevic
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Razvi H. New CUA initiatives. Can Urol Assoc J 2021; 15:300. [PMID: 34665120 DOI: 10.5489/cuaj.7609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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28
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Razvi H. Nouvelles initiatives de l'AUC. Can Urol Assoc J 2021; 15:359. [PMID: 34665125 DOI: 10.5489/cuaj.7622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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29
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Razvi H. Goodbye Zoom, hello Charlottetown! Can Urol Assoc J 2021; 15:226. [DOI: 10.5489/cuaj.7513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bouhadana D, Nguyen DD, Schwarcz J, Gordon H, Elterman DS, Lavallée LT, Martin P, McAlpine K, Paterson R, Razvi H, Zorn KC, Bhojani N. Development of a patient decision aid for the surgical management of lower urinary tract symptoms secondary to benign prostatic hyperplasia. BJU Int 2021; 127:131-135. [PMID: 33369078 DOI: 10.1111/bju.15307] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- David Bouhadana
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | | | - Harvey Gordon
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Luke T Lavallée
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | | | - Kristen McAlpine
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Ryan Paterson
- Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
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Stringer L, Cocco S, Jiang A, Chan EP, Myslik F, Brahm G, Razvi H, Dave S, Wang PZT. Point-of-care ultrasonography for the diagnosis of testicular torsion: a practical resident curriculum. Can J Surg 2021; 64:E191-E195. [PMID: 33739804 PMCID: PMC8064263 DOI: 10.1503/cjs.019119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Prompt Doppler ultrasonography to aid in diagnosis is often key to managing testicular torsion, but there may be delays in access; a faster, more widely available alternative is point-of-care ultrasonography (POCUS). The purpose of this study was to develop and evaluate a scrotal POCUS curriculum for urology and emergency medicine residents. Methods Content experts in urology, emergency medicine and diagnostic imaging collaborated in a modified Delphi method to design a practical didactic curriculum for scrotal POCUS for the identification of testicular torsion. Training included 3 online video teaching modules and a 1-hour hands-on teaching session with standardized adult patients. We evaluated participants’ competency in scrotal POCUS using a validated scale. We assessed participants’ knowledge, comfort and confidence in performing scrotal POCUS before and after the intervention and at 3 months. Results Twenty-four urology (n = 12) and emergency medicine (n = 12) residents participated in the curriculum. After hands-on practice, 23 participants (96%) were deemed competent at scrotal POCUS. Pre–post testing showed significant improvement in knowledge (mean score 63% v. 80%, p < 0.001), comfort (mean Likert score 0.6 v. 3.6, p < 0.001) and confidence (mean Likert score 1.0 v. 2.1, p < 0.001) after the intervention. These effects were maintained at the 3-month assessment. Conclusion The scrotal POCUS curriculum was effective and acceptable to both urology and emergency medicine residents. The findings suggest that scrotal POCUS can be learned effectively through a short hands-on session and didactic instruction.
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Affiliation(s)
- Leandra Stringer
- From the Department of Urology, Western University, London, Ont. (Stringer, Chan, Razvi, Dave, Wang); the Department of Emergency Medicine, Western University, London, Ont. (Cocco, Jiang, Myslik); and the Department of Diagnostic Imaging, Western University, London, Ont. (Brahm)
| | - Sarah Cocco
- From the Department of Urology, Western University, London, Ont. (Stringer, Chan, Razvi, Dave, Wang); the Department of Emergency Medicine, Western University, London, Ont. (Cocco, Jiang, Myslik); and the Department of Diagnostic Imaging, Western University, London, Ont. (Brahm)
| | - Alex Jiang
- From the Department of Urology, Western University, London, Ont. (Stringer, Chan, Razvi, Dave, Wang); the Department of Emergency Medicine, Western University, London, Ont. (Cocco, Jiang, Myslik); and the Department of Diagnostic Imaging, Western University, London, Ont. (Brahm)
| | - Ernest Pang Chan
- From the Department of Urology, Western University, London, Ont. (Stringer, Chan, Razvi, Dave, Wang); the Department of Emergency Medicine, Western University, London, Ont. (Cocco, Jiang, Myslik); and the Department of Diagnostic Imaging, Western University, London, Ont. (Brahm)
| | - Frank Myslik
- From the Department of Urology, Western University, London, Ont. (Stringer, Chan, Razvi, Dave, Wang); the Department of Emergency Medicine, Western University, London, Ont. (Cocco, Jiang, Myslik); and the Department of Diagnostic Imaging, Western University, London, Ont. (Brahm)
| | - Gary Brahm
- From the Department of Urology, Western University, London, Ont. (Stringer, Chan, Razvi, Dave, Wang); the Department of Emergency Medicine, Western University, London, Ont. (Cocco, Jiang, Myslik); and the Department of Diagnostic Imaging, Western University, London, Ont. (Brahm)
| | - Hassan Razvi
- From the Department of Urology, Western University, London, Ont. (Stringer, Chan, Razvi, Dave, Wang); the Department of Emergency Medicine, Western University, London, Ont. (Cocco, Jiang, Myslik); and the Department of Diagnostic Imaging, Western University, London, Ont. (Brahm)
| | - Sumit Dave
- From the Department of Urology, Western University, London, Ont. (Stringer, Chan, Razvi, Dave, Wang); the Department of Emergency Medicine, Western University, London, Ont. (Cocco, Jiang, Myslik); and the Department of Diagnostic Imaging, Western University, London, Ont. (Brahm)
| | - Peter Zhan Tao Wang
- From the Department of Urology, Western University, London, Ont. (Stringer, Chan, Razvi, Dave, Wang); the Department of Emergency Medicine, Western University, London, Ont. (Cocco, Jiang, Myslik); and the Department of Diagnostic Imaging, Western University, London, Ont. (Brahm)
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Tailly T, MacPhee RA, Cadieux P, Burton JP, Dalsin J, Wattengel C, Koepsel J, Razvi H. Evaluation of Polyethylene Glycol-Based Antimicrobial Coatings on Urinary Catheters in the Prevention of Escherichia coli Infections in a Rabbit Model. J Endourol 2021; 35:116-121. [PMID: 32689838 PMCID: PMC7876351 DOI: 10.1089/end.2020.0186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction and Objective: Catheter-associated urinary tract infections are a major cause of patient morbidity and mortality. Despite many attempts to design biomaterials that might reduce the risk, none has had a profound impact on reducing the incidence of this most common nosocomial infection. Recent in vitro work, however, has shown promise for a silver-based biomaterial coating composed of methoxylated polyethylene glycol 3,4-dihydroxyphenylalanine (mPEG-DOPA3) in reducing uropathogen attachment and biofilm formation. The aim of this work was to investigate whether these results translate into a meaningful impact on infection development and bacterial adherence in an in vivo rabbit model. Materials and Methods: New Zealand white rabbits were randomized into groups of 12 and had the following catheters inserted: Group 1-uncoated polyurethane, Group 2-Coating A (mPEG-DOPA3 + 2 mg/mL AgNO3), and Group 3-Coating B (mPEG-DOPA3 + 10 mg/mL AgNO3). Each rabbit was challenged with 108 colony-forming units of Escherichia coli GR-12 instilled directly into the bladder at the time of catheter insertion and urine was monitored over 7 days for bacterial counts. Catheters were retrieved and evaluated for encrustation and attachment analysis, and tissues collected for histopathologic characterization and bacterial invasion. Results: Urinary bacterial colony counts were lower among rabbits in the Coating A group vs controls (4/11 vs 10/12, respectively) (p = 0.029), and there were fewer rabbits with invasive infections (3/12 vs 9/12, p = 0.02). More encrustation was observed among animals in the Coating B group vs controls (7.22 vs 2.69 mg/cm2, p = 0.033). There were no significant differences in tissue effects between groups. Conclusions: The use of a mPEG-DOPA3 urinary catheter coating effectively reduced urinary pathogen counts, while not causing adverse tissue effects in this model. Further clinical evaluation is warranted.
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Affiliation(s)
- Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Rod A. MacPhee
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
| | - Peter Cadieux
- School of Health Sciences, Fanshawe College, London, Canada
| | - Jeremy P. Burton
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | | | | | | | - Hassan Razvi
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Al KF, Denstedt JD, Daisley BA, Bjazevic J, Welk BK, Pautler SE, Gloor GB, Reid G, Razvi H, Burton JP. Ureteral Stent Microbiota Is Associated with Patient Comorbidities but Not Antibiotic Exposure. Cell Rep Med 2020; 1:100094. [PMID: 33205072 PMCID: PMC7659606 DOI: 10.1016/j.xcrm.2020.100094] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/29/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Abstract
Ureteral stents are commonly used to prevent urinary obstruction but can become colonized by bacteria and encrusted, leading to clinical complications. Despite recent discovery and characterization of the healthy urinary microbiota, stent-associated bacteria and their impact on encrustation are largely underexplored. We profile the microbiota of patients with typical short-term stents, as well as over 30 atypical cases (all with paired mid-stream urine) from 241 patients. Indwelling time, age, and various patient comorbidities correlate with alterations to the stent microbiota composition, whereas antibiotic exposure, urinary tract infection (UTI), and stent placement method do not. The stent microbiota most likely originates from adhesion of resident urinary microbes but subsequently diverges to a distinct, reproducible population, thereby negating the urine as a biomarker for stent encrustation or microbiota. Urological practice should reconsider standalone prophylactic antibiotics in favor of tailored therapies based on patient comorbidities in efforts to minimize bacterial burden, encrustation, and complications of ureteral stents.
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Affiliation(s)
- Kait F. Al
- Centre for Human Microbiome and Probiotic Research, Lawson Health Research Institute, London, ON, Canada
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON, Canada
| | - John D. Denstedt
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Brendan A. Daisley
- Centre for Human Microbiome and Probiotic Research, Lawson Health Research Institute, London, ON, Canada
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Blayne K. Welk
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Stephen E. Pautler
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Gregory B. Gloor
- Department of Biochemistry, The University of Western Ontario, London, ON, Canada
| | - Gregor Reid
- Centre for Human Microbiome and Probiotic Research, Lawson Health Research Institute, London, ON, Canada
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON, Canada
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Jeremy P. Burton
- Centre for Human Microbiome and Probiotic Research, Lawson Health Research Institute, London, ON, Canada
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON, Canada
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
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Razvi H. La feuille d’automne, emportée par le vent…. Can Urol Assoc J 2020; 14:E474. [DOI: 10.5489/cuaj.6959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Razvi H. The falling leaves, drift by the window…. Can Urol Assoc J 2020; 14:298. [DOI: 10.5489/cuaj.6924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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36
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Bhojani N, Andonian S, Watterson JD, Dushinski JW, Shayegan B, Schuler TD, Pace KT, Chew BH, Razvi H. Canadian Urological Association best practice report: Holmium:YAG laser eye safety. Can Urol Assoc J 2020; 14:380-382. [PMID: 33259283 DOI: 10.5489/cuaj.6941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Naeem Bhojani
- Department of Urology, University of Montreal, Montreal, QC, Canada
| | - Sero Andonian
- Division of Urology, McGill University, Montreal, QC, Canada
| | - James D Watterson
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - John W Dushinski
- Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Trevor D Schuler
- Divison of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Kenneth T Pace
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hassan Razvi
- Division of Urology, Western University, London, ON, Canada
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37
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Goneau LW, Delport J, Langlois L, Poutanen SM, Razvi H, Reid G, Burton JP. Issues beyond resistance: inadequate antibiotic therapy and bacterial hypervirulence. FEMS Microbes 2020; 1:xtaa004. [PMID: 37333955 PMCID: PMC10117437 DOI: 10.1093/femsmc/xtaa004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/15/2020] [Indexed: 10/15/2023] Open
Abstract
The administration of antibiotics while critical for treatment, can be accompanied by potentially severe complications. These include toxicities associated with the drugs themselves, the selection of resistant organisms and depletion of endogenous host microbiota. In addition, antibiotics may be associated with less well-recognized complications arising through changes in the pathogens themselves. Growing evidence suggests that organisms exposed to antibiotics can respond by altering the expression of toxins, invasins and adhesins, as well as biofilm, resistance and persistence factors. The clinical significance of these changes continues to be explored; however, it is possible that treatment with antibiotics may inadvertently precipitate a worsening of the clinical course of disease. Efforts are needed to adjust or augment antibiotic therapy to prevent the transition of pathogens to hypervirulent states. Better understanding the role of antibiotic-microbe interactions and how these can influence disease course is critical given the implications on prescription guidelines and antimicrobial stewardship policies.
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Affiliation(s)
- Lee W Goneau
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, 268 Grosvenor St, London, Ontario, N6A 4V2 Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto,1 King's College Cir, Toronto, ON M5S 1A8 Ontario, Canada
| | - Johannes Delport
- Department of Pathology, London Health Sciences Center - Victoria Hospital, 800 Commissioners Rd E, London, Ontario, Canada N6A 5W9
| | - Luana Langlois
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Susan M Poutanen
- Department of Laboratory Medicine and Pathobiology, University of Toronto,1 King's College Cir, Toronto, ON M5S 1A8 Ontario, Canada
- Department of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON M5S 1A8 Toronto, Ontario, Canada
- Department of Microbiology, University Health Network and Sinai Health, 190 Elizabeth St. Toronto, ON M5G 2C4, Ontario, Canada
| | - Hassan Razvi
- Lawson Health Research Institute, 268 Grosvenor St, London, Ontario, N6A 4V2 Canada
- Division of Urology, Department of Surgery, Western University, 1151 Richmond St, London, Ontario, N6A 3K7 Canada
| | - Gregor Reid
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, 268 Grosvenor St, London, Ontario, N6A 4V2 Canada
- Division of Urology, Department of Surgery, Western University, 1151 Richmond St, London, Ontario, N6A 3K7 Canada
| | - Jeremy P Burton
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, 268 Grosvenor St, London, Ontario, N6A 4V2 Canada
- Division of Urology, Department of Surgery, Western University, 1151 Richmond St, London, Ontario, N6A 3K7 Canada
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MacPhee RA, Koepsel J, Tailly T, Vangala SK, Brennan L, Cadieux PA, Burton JP, Wattengel C, Razvi H, Dalsin J. Application of Novel 3,4-Dihydroxyphenylalanine-Containing Antimicrobial Polymers for the Prevention of Uropathogen Attachment to Urinary Biomaterials. J Endourol 2020; 33:590-597. [PMID: 31140304 DOI: 10.1089/end.2019.0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction and Objective: Urinary catheters and stents are frequently prone to catheter-associated urinary tract infections (CAUTI) through biofilm formation. Several strategies have been evaluated in search of a stent coating to reliably prevent adherence of bacteria and biofilm. Previous in vivo and in vitro research with methoxylated polyethylene glycol 3,4-dihydroxyphenylalanine (DOPA) copolymer as a candidate coating showed promising results to reduce the bacterial attachment. We aimed to further enhance this antimicrobial activity by adding antimicrobial agents to newly synthesized DOPA-based copolymers. Materials and Methods: Building on our previous experience, novel copolymers were engineered based on DOPA. Quaternary ammonium groups and silver particles were added by cross-linking to increase the antimicrobial activity through both kill-by-contact and planktonic killing. After coating polyurethane sheets and measuring contact angles, all candidate coatings were challenged in vitro with an Escherichia coli culture. The most promising coatings were then further evaluated against a panel of seven clinically relevant uropathogens and planktonic killing, and microbial attachment was determined. Results: Initially, seven coatings were developed, referred to as Surphys 093-099. The most significant increase in contact angle was identified in Surphys-095 and -098. Surphys coatings S-094, S-095, and S-098 were cross-linked with silver and exhibited profound antimicrobial properties when challenged with E. coli. Further testing demonstrated S-095 to have antimicrobial efficacy against gram-positive and gram-negative bacteria at different silver-loading concentrations. The final coating, consisting of a 2 mg/mL solution of S-095 cross-linked with 0.25 mg/mL AgNO3, appeared to be highly bactericidal showing a ≥99.9% bacterial killing effect while remaining below cytotoxicity levels. Conclusions: We were able to engineer DOPA-based copolymers and add quaternary ammonium and silver particles, thus increasing the bactericidal properties of the coating. These coatings have exhibited a biologically significant ability to prevent uropathogens from attaching to biomaterials and represent a realistic opportunity to combat CAUTI.
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Affiliation(s)
| | | | - Thomas Tailly
- 3 Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.,4 Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Sai K Vangala
- 5 Department of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Liam Brennan
- 1 Lawson Health Research Institute, London, Ontario, Canada.,3 Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.,6 Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Peter A Cadieux
- 6 Department of Microbiology and Immunology, Western University, London, Ontario, Canada.,7 School of Health Sciences, Fanshawe College, London, Ontario, Canada
| | - Jeremy P Burton
- 1 Lawson Health Research Institute, London, Ontario, Canada.,3 Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.,6 Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | | | - Hassan Razvi
- 3 Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
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Abstract
Renal echinococcal infection is an uncommonly encountered infection in North America but is endemic in many parts of the world. With increasing migration, it is conceivable that practicing Canadian physicians will see more patients presenting at various stages of infection. Herein, we describe an unusual presentation of primary renal echinococcal infection and describe current diagnostic, as well as medical and surgical management strategies.
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Affiliation(s)
- Jennifer Bjazevic
- Division of Urology, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Dor Golomb
- Division of Urology, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Michael S Silverman
- Division of Infections Diseases, Department of Medicine, University of Western Ontario, London, ON, Canada
| | - Stephen E Pautler
- Division of Urology, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, University of Western Ontario, London, ON, Canada
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Beiko D, Razvi H, Bhojani N, Bjazevic J, Bayne DB, Tzou DT, Stoller ML, Chi T. Techniques - Ultrasound-guided percutaneous nephrolithotomy: How we do it. Can Urol Assoc J 2020; 14:E104-E110. [PMID: 31599714 PMCID: PMC7053366 DOI: 10.5489/cuaj.6076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ultrasonography has emerged as an alternative to fluoroscopy for image-guided percutaneous nephrolithotomy (PCNL) in many countries. Compared to fluoroscopy-guided PCNL (F-PCNL), ultrasound-guided PCNL (US-PCNL) is easier to learn and reduces radiation exposure to patients and providers. Despite these advantages, uptake of ultrasound-guided PCNL (US-PCNL) in Canada has been almost nonexistent, largely because it is not incorporated into urologists' training. In this article, we seek to familiarize Canadian urologists with this approach by describing our step-by-step technique for US-PCNL. Additionally, we provide keys to successful implementation of this technique.
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Affiliation(s)
- Darren Beiko
- Department of Urology, Queen’s University, Kingston, ON, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Naeem Bhojani
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - David B. Bayne
- Department of Urology, University of California at San Francisco, San Francisco, CA, United States
| | - David T. Tzou
- Division of Urology, Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Marshall L. Stoller
- Department of Urology, University of California at San Francisco, San Francisco, CA, United States
| | - Thomas Chi
- Department of Urology, University of California at San Francisco, San Francisco, CA, United States
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Tailly T, Nadeau BR, Violette PD, Bao Y, Amann J, Nott L, Denstedt JD, Razvi H. Stone Burden Measurement by 3D Reconstruction on Noncontrast Computed Tomography Is Not a More Accurate Predictor of Stone-Free Rate After Percutaneous Nephrolithotomy Than 2D Stone Burden Measurements. J Endourol 2020; 34:550-557. [PMID: 32008375 DOI: 10.1089/end.2019.0718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Stone burden has been reported as an independent predictor of stone-free rate after percutaneous nephrolithotomy (PCNL); however no consensus exists on a standardized method for measuring stone burden. Recently, stone volume has been advocated as the most accurate means of measuring stone burden. We aimed to compare different measuring methods of stone burden and to identify the predictive value of each for outcomes after PCNL. Materials and Methods: We performed a retrospective review of a prospective database of patients who underwent PCNL between 2006 and 2013. A preoperative CT and postoperative imaging at discharge were necessary for eligibility. Stone burden was assessed through four different ways on CT images: (1) cumulative stone diameter; (2) estimated SA (surface area) calculated as longest × orthogonal diameter × π/4; (3) manual outline of stone and computer SA calculation; and (4) automated 3D volume calculation using specific software. Primary outcome was stone-free status (SFS) at discharge. Secondary outcomes included operative time and the need for an ancillary procedure. Regression analysis and receiver operating characteristic curve analysis were used to evaluate the predictive value of each method. Results: Of 313 included patients, 69.6% were stone free at discharge. All measures of stone burden were independent predictors of SFS [OR and 95% CI of 1.027 (1.014, 1.040), 1.481 (1.180, 1.858), 1.736 (1.266, 2.380), and 1.311 (1.127, 1.526), respectively] and demonstrated similar predictive accuracy (area under the curve = 0.630, 0.630, 0.627, and 0.638, respectively). Stone burden by any measure was an independent predictor of operative time and secondary procedure. Conclusions: We demonstrated that measuring stone burden by manual outline or automated 3D volume on reformatted CT images had no added value compared with orthogonal measurement for predicting outcomes after PCNL.
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Affiliation(s)
- Thomas Tailly
- Division of Urology, University Hospital Ghent, Ghent, Belgium.,Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Brandon R Nadeau
- Department of Diagnostic Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Philippe D Violette
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Surgery, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yige Bao
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Justin Amann
- Department of Diagnostic Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Linda Nott
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - John D Denstedt
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Hassan Razvi
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Welk B, Reid J, Ordon M, Razvi H, Campbell J. Population-based assessment of re-treatment and healthcare utilisation after photoselective vaporisation of the prostate or electrosurgical transurethral resection of the prostate. BJU Int 2019; 124:1047-1054. [PMID: 31389161 DOI: 10.1111/bju.14891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the healthcare utilisation and repeat surgical treatment rate amongst older men undergoing an electrosurgical-transurethral resection of the prostate (TURP) vs photoselective vaporisation of the prostate (PVP), as the real-world implementation and outcomes of laser-based treatment have not been well studied. PATIENTS AND METHODS We used administrative data from the province of Ontario, Canada, to identify all men aged >66 years who underwent their first electrosurgical-TURP/PVP between 2003 and 2016. Our primary exposure was type of procedure (PVP or electrosurgical-TURP). Our primary outcome was need for repeat surgical treatment. The primary analysis was an adjusted marginal Cox model approach, which accounted for clustering of patients within surgeons; adjusted hazard ratios (aHRs) or odds ratios (aORs) and 95% confidence intervals (CIs) are reported. RESULTS We identified 52 748 men: 6838 (13%) underwent PVP, and 45 910 (87%) underwent electrosurgical-TURP. The median age was similar, and PVP became more common with time. Compared to the PVP group, more patients in the electrosurgical-TURP group had prior gross haematuria or urinary retention, and fewer had used anticoagulants, α-blockers, or 5α-reductase inhibitors. The need for repeat surgical treatment was significantly higher amongst men who had PVP (aHR 1.57, 95% CI 1.38-1.78; absolute risk difference +2.3%). PVP was also associated with a slightly higher risk of return to the emergency room within 30 days (aOR 1.11, 95% CI 1.01-1.22) and a significantly lower risk of blood transfusion (aOR 0.24, CI 0.16-0.37); the majority of PVP cases were done with a <24 h stay (73%) vs electrosurgical-TURP (7%). CONCLUSIONS While some of the expected benefits of PVP (such as reduced transfusion risk and shorter length of stay) were observed, the significantly higher rate of repeat surgical treatment compared to electrosurgical-TURP may represent an important difference in implementation of this technology outside of clinical trials.
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Affiliation(s)
- Blayne Welk
- Department of Surgery, Western University, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Institute for Clinical Evaluative Sciences, London, ON, Canada
| | - Jennifer Reid
- Institute for Clinical Evaluative Sciences, London, ON, Canada
| | - Michael Ordon
- Institute for Clinical Evaluative Sciences, London, ON, Canada.,Department of Surgery, University of Toronto, London, ON, Canada
| | - Hassan Razvi
- Department of Surgery, Western University, London, ON, Canada
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Bjazevic J, Nott L, Violette PD, Tailly T, Dion M, Denstedt JD, Razvi H. The evolution of percutaneous nephrolithotomy: Analysis of a single institution experience over 25 years. Can Urol Assoc J 2019; 13:E317-E324. [PMID: 31364972 DOI: 10.5489/cuaj.5725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Over time, the incidence of nephrolithiasis has risen significantly, and patient populations have become increasingly complex. Our study aimed to determine the impact of changes in patient demographics on percutaneous nephrolithotomy (PCNL) outcomes. METHODS A retrospective analysis of a prospectively collected database was carried out from 1990-2015. Patient demographics, comorbidities, stone and procedure characteristics were analyzed. Multivariate logistic regression was used to evaluate differences in operative duration, complications, stone-free rate, and length of stay. RESULTS A total of 2486 patients with a mean age of 54±15 years, body mass index (BMI) of 31±8, and stone surface area of 895±602 mm2 were analyzed; 47% of patients had comorbidities, including hypertension (22%), diabetes mellitus (14%), and cardiac disease (13%). Complication rate was 19%, including a 2% rate of major complications (Clavien grade III-V). There was a statistically significant increase in patient age, BMI, and comorbidities over time, which was correlated with an increased complication rate (odds ratio [OR] 1.15; p=0.010). The overall transfusion rate was 1.0% and remained stable (p=0.131). With time, both OR duration (mean Δ 16 minutes; p<0.001) and hospital length of stay (mean Δ 2.4 days; p<0.001) decreased significantly. Stone-free rate of 1873 patients with available three-month followup was 87% and decreased significantly over time (OR 1.09; p<0.001), but was correlated with an increased use of computed tomography (CT) scans for followup imaging. CONCLUSIONS Despite an increasingly complex patient population, PCNL remains a safe and effective procedure with a high stone-free rate and low risk of complications.
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Affiliation(s)
| | - Linda Nott
- Division of Urology, Western University, London, ON, Canada
| | | | - Thomas Tailly
- Division of Urology, Ghent University, Ghent, Belgium
| | | | | | - Hassan Razvi
- Division of Urology, Western University, London, ON, Canada
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Alathel A, Bjazevic J, Chew BH, Pace KT, Razvi H. The New/Novel Oral Anticoagulants and Their Impact on Patients Being Considered for Shockwave Lithotripsy: The Findings of an International Survey of the Endourological Society. J Endourol 2019; 33:319-324. [PMID: 30793937 DOI: 10.1089/end.2019.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Although general guidelines exist directing the management of new/novel oral anticoagulants (NOACs) in the perioperative period for open/endoscopic procedures, no consensus exists for those patients being considered for shockwave lithotripsy (SWL). To gauge current practice, we administered a survey to the international endourologic community. METHODS A web-based survey was sent to current Endourological Society members. Respondents were asked whether they would consider SWL in patients receiving NOACs, and if they used SWL how these agents were managed perioperatively. Respondents were also asked which physicians in the patients' circle of care managed the discontinuation and reinstitution of the drugs. RESULTS There were 165 respondents from 27 countries. Approximately 92.7% of urologists had access to SWL but only 53.4% indicated they would offer SWL to patients receiving NOACs. Among these urologists, 63.3% relied on internal medicine/hematology/cardiology colleagues to counsel patients on the discontinuation of NOACs pretreatment, whereas the majority (64%) handled the resumption guidance themselves. There was wide variability in the management of NOACs before lithotripsy, with discontinuation varying from 2 to 7 days. Resumption was more consistent, ranging from 1 to 2 days or when hematuria resolved. None of the respondents reported knowledge of adverse effects such as perinephric hematomas or cardiovascular morbidity. CONCLUSIONS A large percentage of globally surveyed endourologists do not offer SWL to patients who are taking NOACs. Among those that do offer SWL, there seems to be a absence of consensus on optimal duration of discontinuation, suggesting a need to establish evidence-based guidance to optimize patient outcomes.
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Affiliation(s)
- Abdulaziz Alathel
- 1 Division of Urology, Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- 2 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- 3 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jennifer Bjazevic
- 4 Division of Urology, Department of Surgery, Western University, London, Canada
| | - Ben H Chew
- 5 Department of Urological Sciences, University of British Columbia, Vancouver, Canada
| | - Kenneth T Pace
- 6 Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Hassan Razvi
- 4 Division of Urology, Department of Surgery, Western University, London, Canada
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Beiko D, Honey RJD, Pace KT, Denstedt JD, Razvi H, Hosking DH, Norman RW, Wilson JWL. Celebrating 75 years. Can Urol Assoc J 2019; 14:12-16. [PMID: 31364975 DOI: 10.5489/cuaj.5747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Following the introduction of shock wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL), the subspecialty of endourology was born in the late 1970s. The purpose of this study was to report milestones in Canadian endourology, highlighting Canada's contributions to the field. METHODS A review of the literature was performed from the late 1970s to the present. The literature review included bibliographic and digital resources. Additionally, records and recollections by various individuals were used, including some who were directly involved. RESULTS Endourology was born in Canada when SWL, URS, and PCNL emerged as minimally invasive treatment options for stones in the early to mid-1980s. According to our research, the first PCNL was performed at the University of Toronto in 1981. Dr. Joachim Burhenne, a Harvard-trained radiologist from Germany, first used extracorporeal SWL in Canada at the University of British Columbia (UBC) for the treatment of biliary stones. Treatment for urinary tract stones followed at UBC and Dalhousie University. The first worldwide use of the holmium laser for lithotripsy of urinary tract calculi took place at the University of Western Ontario. Other endourology milestones in Canada include the formation of the Canadian Endourology Group and the emergence of the Endourological Society-accredited fellowship programs at the University of Toronto and Western University in the 1990s. Canada hosted the 21st and 35th World Congress of Endourology and Shock Wave Lithotripsy annual meeting in Montreal and Vancouver, respectively. CONCLUSIONS Canadian urologists have led many advances in SWL, URS, and PCNL over the past four decades and, for a relatively small community, have made significant contributions to the field. Through the training of the next generation of endourologists at Canadian institutions, the future of endourology in Canada is bright.
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Affiliation(s)
- Darren Beiko
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - R John D'A Honey
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kenneth T Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - John D Denstedt
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Denis H Hosking
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Richard W Norman
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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Ali SN, Dayarathna TK, Ali AN, Osumah T, Ahmed M, Cooper TT, Power NE, Zhang D, Kim D, Kim R, St Amant A, Hou J, Tailly T, Yang J, Luyt L, Spagnuolo PA, Burton JP, Razvi H, Leong HS. Drosophila melanogaster as a function-based high-throughput screening model for antinephrolithiasis agents in kidney stone patients. Dis Model Mech 2018; 11:dmm.035873. [PMID: 30082495 PMCID: PMC6262805 DOI: 10.1242/dmm.035873] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/25/2018] [Indexed: 01/24/2023] Open
Abstract
Kidney stone disease involves the aggregation of stone-forming salts consequent to solute supersaturation in urine. The development of novel therapeutic agents for this predominantly metabolic and biochemical disorder have been hampered by the lack of a practical pre-clinical model amenable to drug screening. Here, Drosophila melanogaster, an emerging model for kidney stone disease research, was adapted as a high-throughput functional drug screening platform independent of the multifactorial nature of mammalian nephrolithiasis. Through functional screening, the therapeutic potential of a novel compound commonly known as arbutin that specifically binds to oxalate, a key component of kidney calculi, was identified. Through isothermal titration calorimetry, high-performance liquid chromatography and atomic force microscopy, arbutin was determined to interact with calcium and oxalate in both free and bound states, disrupting crystal lattice structure, growth and crystallization. When used to treat patient urine samples, arbutin significantly abrogated calculus formation in vivo and outperformed potassium citrate in low pH urine conditions, owing to its oxalate-centric mode of action. The discovery of this novel antilithogenic compound via D. melanogaster, independent of a mammalian model, brings greater recognition to this platform, for which metabolic features are primary outcomes, underscoring the power of D. melanogaster as a high-throughput drug screening platform in similar disorders. This is the first description of the use of D. melanogaster as the model system for a high-throughput chemical library screen. This article has an associated First Person interview with the first authors of the paper.
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Affiliation(s)
- Sohrab N Ali
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Thamara K Dayarathna
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Aymon N Ali
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Tijani Osumah
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mohamed Ahmed
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Tyler T Cooper
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Nicholas E Power
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Dongxing Zhang
- Department of Mechanical and Materials Engineering, Western University, London, ON N6A 5B9, Canada
| | - Dajung Kim
- Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Rachel Kim
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Andre St Amant
- Department of Chemistry, University of Santa Barbara, CA 93106, USA
| | - Jinqiang Hou
- Department of Chemistry, Western University, London, ON N6A 3K7, Canada
| | - Thomas Tailly
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada
| | - Jun Yang
- Department of Mechanical and Materials Engineering, Western University, London, ON N6A 5B9, Canada
| | - Len Luyt
- Department of Chemistry, Western University, London, ON N6A 3K7, Canada
| | - Paul A Spagnuolo
- Faculty of Food Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jeremy P Burton
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada
| | - Hon S Leong
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada .,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada.,Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
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Navaratnam R, Razvi H, Power N. Case: Causation vs. correlation: Naturopathic medicine vs. natural history of a disease. Can Urol Assoc J 2018; 12:E484-E485. [PMID: 29989881 DOI: 10.5489/cuaj.5058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Hassan Razvi
- Department of Surgery (Urology), Western University, London, ON, Canada.,Department of Surgical Oncology, Western University, London, ON, Canada
| | - Nicholas Power
- Department of Surgery (Urology), Western University, London, ON, Canada.,Department of Surgical Oncology, Western University, London, ON, Canada
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Abstract
Urinary stone disease is a highly prevalent condition affecting approximately 10% of the population, and has increased in incidence significantly over the past 20 years. Along with this, the rate of stone disease among women and children is also on the rise. The management of stone disease in specific populations, such as in children and during pregnancy can present unique challenges to the urologist. In both populations, a multi-disciplinary approach is strongly recommended given the complexities of the patients. Prompt and accurate diagnosis requires a high degree of suspicion and judicious use of diagnostic imaging given the higher risks of radiation exposure. In general, management proceeds from conservative to more invasive approaches and must be individualized to the patient with careful consideration of the potential adverse effects. However, innovations in endourologic equipment and techniques have allowed for the wider application of surgical stone treatment in these patients, and significant advancement in the field. This review covers the history and current advances in the diagnosis and management of stone disease in pregnant and pediatric populations. It is paramount for the urologist to understand the complexities of properly managing stones in these patients in order to maximize treatment efficacy, while minimizing complications and morbidity.
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Affiliation(s)
- Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, Canada
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Alathel A, Bjazevic J, Nott L, Razvi H. MP31-16 THE IMPACT OF REDUCING DIETARY SODIUM IN HYPERCALCIURIC STONE FORMERS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lin S, Lian D, Liu W, Haig A, Lobb I, Hijazi A, Razvi H, Burton J, Whiteman M, Sener A. Daily therapy with a slow-releasing H 2S donor GYY4137 enables early functional recovery and ameliorates renal injury associated with urinary obstruction. Nitric Oxide 2018. [PMID: 29522906 DOI: 10.1016/j.niox.2018.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To assess the effects of slow-releasing H2S donor GYY4137 on post-obstructive renal function and injury following unilateral ureteral obstruction (UUO) by using the UUO and reimplantation (UUO-R) model in rats and to elucidate potential mechanisms by using an in vitro model of epithelial-mesenchymal transition (EMT). METHODS Male Lewis rats underwent UUO at the left ureterovesical junction. From post-operative day (POD) 1-13, rats received daily intraperitoneal (IP) injection of phosphate buffered saline (PBS, 1 mL) or GYY4137 (200 μmol/kg/day in 1 mL PBS, IP). On POD 14, the ureter was reimplanted back into the bladder, followed by a right nephrectomy. Urine and serum samples were collected to monitor renal function. On POD 30, the left kidney was removed and tissue sections were stained with H&E, TUNEL, CD68, CD206, myeloperoxidase, and Masson's trichrome to determine cortical thickness, apoptosis, inflammation, and fibrosis. In our in vitro model of EMT, NRK52E cells were treated with 10 ng/mL TGF-β1, 10 μM GYY4137 and/or 50 μM GYY4137. Western blot analysis was performed to determine the expression of E-cadherin, vimentin, Smad7 and TGF-β1 receptor II (TβRII). RESULTS GYY4137 led to a moderate decrease in post-obstructive serum creatinine, cystatin C and FENa. We also observed a trend towards a decrease in post-obstructive proteinuria following GYY4137 treatment. Histologically, we observed a significant decrease in apoptosis, inflammation, and fibrosis. Furthermore, our in vitro studies demonstrate that in the presence of TGF-β1, GYY4137 significantly decreases vimentin and TβRII and significantly increases E-cadherin and Smad7. CONCLUSIONS H2S may help to accelerate the recovery of renal function post-obstruction and attenuates renal injury associated with UUO. It is possible that H2S mitigates fibrosis by regulating the TGF-β1-mediated EMT pathway. Taken together, our data suggest that H2S may be a potential novel therapy for improving renal function and limiting renal injury associated with obstructive uropathy.
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Affiliation(s)
- Shouzhe Lin
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada; Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Center, London, Ontario, Canada
| | - Dameng Lian
- Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Center, London, Ontario, Canada
| | - Weihua Liu
- Department of Pathology, Western University, London, Ontario, Canada
| | - Aaron Haig
- Department of Pathology, Western University, London, Ontario, Canada
| | - Ian Lobb
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Center, London, Ontario, Canada
| | - Ahmed Hijazi
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Hassan Razvi
- Department of Surgery, Western University, London, Ontario, Canada
| | - Jeremy Burton
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Matthew Whiteman
- University of Exeter Medical School, University of Exeter, Exeter, Devon, United Kingdom
| | - Alp Sener
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada; Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada; Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Center, London, Ontario, Canada.
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