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Lavasani SAM, Rojhani A, Cumpanas AD, Osann K, Morgan KL, Hernandez MC, McCormac A, Piedras P, Vo K, Gorgen ARH, Sharifi SHH, Gao BM, Tano ZE, Patel RM, Landman J, Clayman RV. Surgical Force: Initial Study and Clinical Implications in the Assessment of Ureteral Access Sheath Induced Injury. J Endourol 2024; 38:316-322. [PMID: 38243836 DOI: 10.1089/end.2023.0548] [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: 01/22/2024] Open
Abstract
Purpose: Ureteral access sheaths (UAS) pose the risk of severe ureteral injury. Our prior studies revealed forces ≤6 Newtons (N) prevent ureteral injury. Accordingly, we sought to define the force urologists and residents in training typically use when placing a UAS. Materials and Methods: Among urologists and urology residents attending two annual urological conferences in 2022, 121 individuals were recruited for the study. Participants inserted 12F, 14F, and 16F UAS into a male genitourinary model containing a concealed force sensor; they also provided demographic information. Analysis was completed using t-tests and Chi-square tests to identify group differences when passing a 16F sheath UAS. Participant traits associated with surpassing or remaining below a minimal force threshold were also explored through polychotomous logistic regression. Results: Participant force distributions were as follows: ≤4N (29%), >6N (45%), and >8N (32%). More years of practice were significantly associated with exerting >6N relative to forces between 4N and 6N; results for >8N relative to 4N and 8N were similar. Compared to high-volume ureteroscopists (those performing >20 ureteroscopies/month), physicians performing ≤20 ureteroscopies/month were significantly less likely to exert forces ≤4N (p = 0.017 and p = 0.041). Of those surpassing 6N and 8N, 15% and 18%, respectively, were high-volume ureteroscopists. Conclusions: Despite years of practice or volume of monthly ureteroscopic cases performed, most urologists failed to pass 16F access sheaths within the ideal range of 4N to 6N (74% of participants) or within a predefined safe range of 4N to 8N (61% of participants).
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Affiliation(s)
| | - Allen Rojhani
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Andrei D Cumpanas
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Kathryn Osann
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, California, USA
| | - Kalon L Morgan
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Mariah C Hernandez
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Amanda McCormac
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Paul Piedras
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Kelvin Vo
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Antonio R H Gorgen
- Department of Urology, University of California, Irvine, Orange, California, USA
| | | | - Bruce M Gao
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
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Piedras P, Cumpanas AD, McCormac A, Lavasani SAM, Gorgen ARH, Rojhani A, Vu MC, Bhatt R, Asplin J, Tano ZE, Landman J, Clayman RV, Patel RM. Alkaline Water: Help or Hype for Uric Acid and Cystine Urolithiasis? J Urol 2024; 211:276-284. [PMID: 38193415 DOI: 10.1097/ju.0000000000003767] [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: 08/02/2023] [Accepted: 10/20/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE The consumption of alkaline water, water with an average pH of 8 to 10, has been steadily increasing globally as proponents claim it to be a healthier alternative to regular water. Urinary alkalinization therapy is frequently prescribed in patients with uric acid and cystine urolithiasis, and as such we analyzed commercially available alkaline waters to assess their potential to increase urinary pH. MATERIALS AND METHODS Five commercially available alkaline water brands (Essentia, Smart Water Alkaline, Great Value Hydrate Alkaline Water, Body Armor SportWater, and Perfect Hydration) underwent anion chromatography and direct chemical measurements to determine the mineral contents of each product. The alkaline content of each bottle of water was then compared to that of potassium citrate (the gold standard for urinary alkalinization) as well as to other beverages and supplements used to augment urinary citrate and/or the urine pH. RESULTS The pH levels of the bottled alkaline water ranged from 9.69 to 10.15. Electrolyte content was minimal, and the physiologic alkali content was below 1 mEq/L for all brands of alkaline water. The alkali content of alkaline water is minimal when compared to common stone treatment alternatives such as potassium citrate. In addition, several organic beverages, synthetic beverages, and other supplements contain more alkali content than alkaline water, and can achieve the AUA and European Association of Urology alkali recommendation of 30 to 60 mEq per day with ≤ 3 servings/d. CONCLUSIONS Commercially available alkaline water has negligible alkali content and thus provides no added benefit over tap water for patients with uric acid and cystine urolithiasis.
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Affiliation(s)
- Paul Piedras
- Department of Urology, University of California, Irvine, Orange, California
| | - Andrei D Cumpanas
- Department of Urology, University of California, Irvine, Orange, California
| | - Amanda McCormac
- Department of Urology, University of California, Irvine, Orange, California
| | | | - Antonio R H Gorgen
- Department of Urology, University of California, Irvine, Orange, California
| | - Allen Rojhani
- Department of Urology, University of California, Irvine, Orange, California
| | - Minh-Chau Vu
- Department of Urology, University of California, Irvine, Orange, California
| | - Rohit Bhatt
- Department of Urology, University of California, Irvine, Orange, California
| | - John Asplin
- Litholink Corporation, Labcorp, Ithasca, Illinois
| | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, California
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California
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Sharifi SHH, Wu YX, Lavasani SAM, Tano ZE, Ali SN, Gao BM, Saadat S, Piedras P, Nourbakhsh M, Jiang P, Patel RM, Landman J, Clayman RV. Electromotive Drug Administration in the Porcine Renal Pelvis: First Report. J Endourol 2024; 38:77-81. [PMID: 37842848 DOI: 10.1089/end.2023.0418] [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: 10/17/2023] Open
Abstract
Introduction: Electromotive Drug Administration (EMDA) amplifies drug delivery deep into targeted tissues. We tested, for the first time, the ability of EMDA to deliver methylene blue into the urothelium of the renal pelvis. Materials and Methods: In an anesthetized female pig, both proximal ureters were transected two inches distal to the ureteropelvic junction. An 8F dual lumen catheter and a 5F fenestrated catheter with an indwelling silver wire were inserted into both renal pelvises following which methylene blue (0.1%) was infused at a rate of 5 mL/min for 20 minutes. In one pelvis, a 4 mA positive pulsed electrical current was applied to the silver wire. Results: In contrast to the control pelvis, the EMDA side macroscopically exhibited dense homogeneous staining; microscopy revealed penetration of methylene blue into the urothelium/lamina propria. Conclusion: In the porcine renal pelvis, application of EMDA increased the penetration of a charged molecule into the urothelium/lamina propria.
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Affiliation(s)
| | - Yi Xi Wu
- Department of Urology, University of California, Irvine, Orange, California, USA
| | | | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Sohrab Naushad Ali
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Bruce M Gao
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Seyedamirvala Saadat
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Paul Piedras
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Mahra Nourbakhsh
- Department of Pathology, University of California, Irvine, Orange, California, USA
| | - Pengbo Jiang
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
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Sharifi SHH, Ali SN, Wu YX, Tano ZE, Lavasani SAM, Nourbakhsh M, Jiang P, Patel RM, Landman J, Clayman RV. Electromotive Drug Administration in the Ureter in an In Vivo Animal Model: Initial Report. J Endourol 2023; 37:823-827. [PMID: 37221871 DOI: 10.1089/end.2023.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/25/2023] Open
Abstract
Introduction: Electromotive drug administration (EMDA) delivers a drug deeply into targeted tissues, such as the bladder. EMDA has never been applied to the ureter. Methods: In four in vivo porcine ureters, a unique EMDA catheter containing a silver conducting wire was advanced for the infusion of methylene blue. In two ureters, a pulsed current was delivered through an EMDA machine, whereas the other two ureters served as a control. After 20 minutes of infusion, the ureters were harvested. Results: In the EMDA ureter, there was diffuse staining of the urothelium; penetration of methylene blue occurred in the lamina propria and muscularis propria. In the control ureter, there was only patchy staining of the urothelium. Conclusion: In this first report of ureteral EMDA, a charged molecule penetrated beyond the urothelium into the lamina propria and muscularis propria of the porcine ureter.
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Affiliation(s)
| | - Sohrab Naushad Ali
- Department of Urology, University of California, Irvine, California, USA
| | - Yi Xi Wu
- Department of Urology, University of California, Irvine, California, USA
| | - Zachary E Tano
- Department of Urology, University of California, Irvine, California, USA
| | | | - Mahra Nourbakhsh
- Department of Pathology, University of California, Irvine, California, USA
| | - Pengbo Jiang
- Department of Urology, University of California, Irvine, California, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, California, USA
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