Comparison of stone-free rates following shock wave lithotripsy, percutaneous nephrolithotomy, and retrograde intrarenal surgery for treatment of renal stones: A systematic review and network meta-analysis

OBJECTIVES

To perform a systematic review and network meta-analysis comparing stone-free rates following retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) treatments of renal stones.

MATERIALS AND METHODS

Clinical trials comparing RIRS, SWL, and PCNL for treatment of renal stones were identified from electronic databases. Stone-free rates for the procedures were compared by qualitative and quantitative syntheses (meta-analyses). Outcome variables are shown as risk ratios (ORs) with 95% credible intervals (CIs).

RESULTS

A total of 35 studies were included in this network meta-analysis of success and stone-free rates following three different treatments of renal stones. Six studies compared PCNL versus SWL, ten studies compared PCNL versus RIRS, fourteen studies compared RIRS versus SWL, and five studies compared PCNL, SWL, and RIRS. The quality scores within subscales were relatively low-risk. Network meta-analyses indicated that stone-free rates of RIRS (OR 0.38; 95% CI 0.22-0.64) and SWL (OR 0.12; 95% CI 0.067-0.19) were lower than that of PCNL. In addition, stone-free rate of SWL was lower than that of RIRS (OR 0.31; 95% CI 0.20-0.47). Stone free rate of PCNL was also superior to RIRS in subgroup analyses including ≥ 2 cm stone (OR 4.680; 95% CI 2.873-8.106), lower pole stone (OR 1.984; 95% CI 1.043-2.849), and randomized studies (OR 2.219; 95% CI 1.348-4.009). In rank-probability test, PCNL was ranked as No. 1 and SWL was ranked as No. 3.

CONCLUSIONS

PCNL showed the highest success and stone-free rate in the surgical treatment of renal stones. In contrast, SWL had the lowest success and stone-free rate.

Stone heterogeneity index on single-energy noncontrast computed tomography can be a positive predictor of urinary stone composition

The aim of this study was to investigate the correlation between stone composition and single-energy noncontrast computed tomography (NCCT) parameters, including stone heterogeneity index (SHI) and mean stone density (MSD), in patients with urinary calculi. We retrospectively reviewed medical records of 255 patients who underwent operations or procedures for urinary stones or had spontaneous stone passage between December 2014 and October 2015. Among these, 214 patients with urinary calculi who underwent NCCT and stone composition analyses were included in the study. Maximal stone length (MSL), mean stone density (MSD), and stone heterogeneity index (SHI) were determined on pretreatment NCCT. The mean MSD (454.68±177.80 HU) and SHI (115.82±96.31 HU) of uric acid stones were lower than those of all other types. Based on post hoc tests, MSD was lower for uric acid stones than for the other types (vs. CaOx: P<0.001; vs. infection stones: P<0.001). SHI was lower for uric acid stones than for the other types (vs. CaOx: P<0.001; vs. infection stones: P<0.001) Receiver operating characteristic curves of uric acid stones for MSD and SHI demonstrated that SHI (cut-off value: 140.4 HU) was superior to MSD (cut-off value: 572.3 HU) in predicting uric acid stones (P<0.001).

The effect of two weeks of treatment with dutasteride on bleeding after transurethral resection of the prostate

PURPOSE

Dutasteride affects the prostate by reducing intraprostatic dihydrotestosterone and prostate tissue vascularity. We evaluated the effect of pretreatment with dutasteride for two weeks on perioperative and postoperative bleeding during transurethral resection of the prostate (TURP).

MATERIALS AND METHODS

Eighty-three patients who had benign prostatic hyperplasia together with the criteria for eligibility for TURP were included. The dutasteride group consisted of 40 patients who were treated with dutasteride (0.5 mg/d) for two weeks before surgery, and the control group consisted of 43 patients who did not receive dutasteride. Blood loss was evaluated in terms of reduction in serum hemoglobin (Hb) and hematocrit (Hct) levels, which were measured before, immediately after, and 24 hours after surgery. We also measured the durations of indwelling urethral catheter use, continuous saline bladder irrigation, and hospitalization.

RESULTS

Lower mean blood loss was observed in the dutasteride group than the control group immediately after and 24 hours after surgery (ΔHb=0.65±1.27 g/dL vs. 1.16±0.73 g/dL, 1.30±1.00 g/dL vs. 1.86±1.05 g/dL respectively, p=0.019, p=0.011; ΔHct=1.89%±3.83% vs. 3.47%±2.09%, 3.69%±2.95% vs. 5.39%±3.23% respectively, p=0.016, p=0.011). In addition, there were fewer days of indwelling urethral catheter use (2.95±1.02 d vs. 3.92±1.14 d, p=0.000), continuous saline bladder irrigation (1.81±1.08 d vs. 2.36±1.06 d, p=0.016), and hospitalization after TURP (3.95±1.09 d vs. 4.76±1.19 d, p=0.001) in the dutasteride group.

CONCLUSIONS

Preoperative treatment with dutasteride for two weeks before TURP reduces surgical bleeding and length of hospitalization after TURP. This pretreatment can be used to decrease surgical bleeding associated with TURP.

Cloning, sequencing, and expression of porcine interleukin-18 in Escherichia coli

IL-18 is the new name of a novel cytokine that plays an important role in T(H1) response, primarily by its ability to induce IFN-gamma production in T cells and natural killer cells. The porcine IL-18 gene was isolated using RT-PCR from porcine alveolar macrophages. Sequence analysis of the porcine IL-18 gene has demonstrated an open reading frame of 579 base pairs encoding 192 amino acids precursor protein with a predicted molecular mass of 22 kDa. The porcine IL-18 gene shares 84% and 89% similarity to the human and canine equivalents, respectively, at the nucleotide level. The cloned IL-18 was expressed in Escherichia coli and its expression was confirmed by SDS-PAGE and Western blotting.

Clothing selection behavior of the aged women for thermal comfort

Wearing behavior and thermoregulatory responses of five young women (YG; 20 +/- 1 yr) and five aged women (AG; 65 +/- 3 yr) to indoor cold in summer were investigated in this study. The subjects were exposed to 21.0 +/- 0.5 degrees C and 55 +/- 5% RH while seated during a 90-minute experiment. The subjects were allowed to select and wear for thermal comfort clothing whenever they needed additional clothing during the experiment. Rectal temperature (Tre) and temperatures of 7 sites (head, chest, forearm, hand, thigh, leg, foot) of the skin of the subjects were measured every 10 minutes. Mean skin temperature (Tsk) of the subject was obtained every 10 minutes. First selection time of additional clothing was monitored and weight of selected total clothing was calculated. The results for this study were as follows: Tre and Tsk gradually decreased in YG and AG, however Tre decreased less than Tsk which decreased greater in AG than YG (p < 0.01). AG's first selection of additional clothing and thermal sensation response were slower than YG's. Furthermore, total clothing weight was less in AG than YG. It was concluded that clothing selection behavior would modify the intrinsic thermoregulatory responses of the aged women to the cold stress in the summer.

[Rapid detection of Theileria sergenti by polymerase chain reaction]

Four separate pairs of oligonucleotide primers within the coding region in a T. sergenti 33-kDa surface protein gene were selected to detect T. sergenti by PCR. The specificity of PCR-amplified DNA was examined by digestion with restriction enzyme and Southern blot hybridization using T. sergenti p33 DNA probe. PCR appears to be specific for T. sergenti, without detectable signals from uninfected erythrocytes, uninfected bovine leukocytes and other hemoparasites, including A. marginale and B. ovata. Although 46 of 71 specimens (64.8%) from grazing cattle were microscopically positive, PCR in this study showed that 64 specimens (88.7%) were positive. Therefore, PCR proves a useful diagnostic tool for detecting T. sergenti-infected cattle. In addition, it is also revealed that PCR was significantly more sensitive than traditional microscopic examination using Giemsa's stain.

Different thermal conditions of the extremities affect thermoregulation in clothed man

The effects of different types of clothing on human deep body temperature were studied with six healthy male subjects in a supine posture. Two clothing ensembles were employed for the present study: A covered the whole body area with garments except the face (1.97 clo) and B covered only the trunk and the upper half of the extremities with garments (1.53 clo). The experiment was carried out in a climatic chamber at 55% +/- 5% relative humidity under cooling and warming temperatures: the temperature was changed from 22 degrees C to 10 degrees C (cooling) and returned to 22 degrees C again (warming). The major findings were: rectal temperature (T(re)) continued to decrease gradually in A throughout the experiment, whereas in B it increased during cooling, and returned to previous levels during warming. As a result, T(re) and chest skin temperature were maintained at a higher level in B than in A. Internal tissue conductances were greater in A than in B both during cooling and during warming. Thermal comfort appeared to have been influenced more by the rate of skin temperature change than by the level of skin temperature per se. It was concluded that peripheral vasoconstriction in B induced less heat flow from core to shell, and, thus, the core temperature was maintained at a higher level in B than in A.

Circadian rhythm of rectal temperature in man with two different types of clothing

We compared the circadian rhythm of human rectal temperature with two different types of clothing at an ambient temperature of 27.5 degrees +/- 0.5 degrees C and a relative humidity of 40 +/- 10%. One clothing covered the whole body area except for the head, hands and feet (Type A, weight 475 g, 0.98 clo), the other covered the trunk, upper arms and thighs (Type B, weight 366 g, 0.93 clo). Major findings are summarized as follows: (1) Late evening fall after retiring and a morning rise after rising in the rectal temperature rhythm were significantly quicker in Type B than in Type A. (2) Late evening rise after retiring and a morning fall after rising in the skin temperatures of the extremities were quicker in Type B than in Type A. (3) A range of oscillation in the circadian rectal temperature rhythm was significantly larger in Type B than in Type A. It was suggested that the quicker late evening rise and morning fall of the skin temperatures in the extremities after retiring and rising, respectively, might be responsible for the quicker late evening fall and morning rise of the circadian rectal temperature.

Effects of wearing two different forms of garment on thermoregulation in men resting at 10 degrees C

We have compared the human thermoregulatory responses and clothing microclimate temperature when the body core-shell ratio was changed by wearing two different forms of garment. Each was worn for 160 min at an ambient temperature of 10 degrees C and a relative humidity of 50% by six healthy males in the supine posture. One garment covered the whole body area except for the face (long-sleeves: L-S), the other covered the central body area alone (half-sleeves: H-S). Major findings are summarized as follows: 1) Rectal temperature was kept higher by H-S than L-S even though L-S showed higher thermal resistance values. 2) The standard deviation of rectal temperature was smaller in H-S. 3) Trunk skin and clothing microclimate temperatures were also kept higher by H-S. We suggest that the reduced level of rectal temperature in L-S might be ascribed to a different pattern of venous return originating in the mechanisms of the counter-current heat exchange system: the venous return from the periphery into the thoracic and abdominal areas being cooler in L-S than in H-S.