Kyle Spradling

Applications of three-dimensional printing technology in urological practice.

A rapid expansion in the medical applications of three‐dimensional (3D)‐printing technology has been seen in recent years. This technology is capable of manufacturing low‐cost and customisable surgical devices, 3D models for use in preoperative planning and surgical education, and fabricated biomaterials. While several studies have suggested 3D printers may be a useful and cost‐effective tool in urological practice, few studies are available that clearly demonstrate the clinical benefit of 3D‐printed materials. Nevertheless, 3D‐printing technology continues to advance rapidly and promises to play an increasingly larger role in the field of urology. Herein, we review the current urological applications of 3D printing and discuss the potential impact of 3D‐printing technology on the future of urological practice.

Redefining the Autonomic Nerve Distribution of the Bladder Using 3-Dimensional Image Reconstruction

PURPOSE We sought to create a 3-dimensional reconstruction of the autonomic nervous tissue innervating the bladder using male and female cadaver histopathology. MATERIALS AND METHODS We obtained bladder tissue from a male and a female cadaver. Axial cross sections of the bladder were generated at 3 to 5 mm intervals and stained with S100 protein. We recorded the distance between autonomic nerves and bladder mucosa. We manually demarcated nerve tracings using ImageScope software (Aperio, Vista, California), which we imported into Blender™ graphics software to generate 3-dimensional reconstructions of autonomic nerve anatomy. RESULTS Mean nerve density ranged from 0.099 to 0.602 and 0.012 to 0.383 nerves per mm2 in female and male slides, respectively. The highest concentrations of autonomic innervation were located in the posterior aspect of the bladder neck in the female specimen and in the posterior region of the prostatic urethra in the male specimen. Nerve density at all levels of the proximal urethra and bladder neck was significantly higher in posterior vs anterior regions in female specimens (0.957 vs 0.169 nerves per mm2, p<0.001) and male specimens (0.509 vs 0.206 nerves per mm2, p=0.04). CONCLUSIONS Novel 3-dimensional reconstruction of the bladder is feasible and may help redefine our understanding of human bladder innervation. Autonomic innervation of the bladder is highly focused in the posterior aspect of the proximal urethra and bladder neck in male and female bladders.

Prevalence of Hyperoxaluria in Urinary Stone Formers: Chronological and Geographical Trends and a Literature Review

PURPOSE To report chronological trends and geographical distributions related to the prevalence of hyperoxaluria in stone-forming patients. MATERIALS AND METHODS We systematically reviewed the existing literature between 1982 and 2013 seeking studies that assessed for hyperoxaluria (>45 mg/day [499.5 μmol/24 hour]) in recurrent stone formers. Studies that performed 24-hour urine analysis for urine oxalate in patients with recurrent urinary stones were included. Studies were divided chronologically and by geographical region, and prevalence rates of hyperoxaluria were compared between groups. RESULTS Our literature search provided 22 peer-reviewed articles involving 3636 patients in total. Ten studies were performed between 1982 and 2000, and 12 studies were performed between 2001 and 2013. The prevalence of hyperoxaluria in stone-forming patient cohorts was 24.8% and 45.1% (p = 0.019) in studies performed between 1982 and 2000 and 2001 and 2013, respectively. Hyperoxaluria rates were significantly higher in non-American cohorts compared with American cohorts (40.7% vs 23.0%; p = 0.018). Reported hyperoxaluria rates were higher in Asian countries compared with Western countries (56.8% and 23.8%; p < 0.001). CONCLUSIONS The prevalence of hyperoxaluria in stone-forming patients has increased over the past two decades and may be a contributing factor to the rising global prevalence of urolithiasis. A geographical disparity in hyperoxaluria may exist between Asian and Western countries. Future studies are needed to explain these trends and their consequences.

Lymphovascular invasion is associated with oncologic outcomes following radical cystectomy for squamous cell carcinoma of the urinary bladder

OBJECTIVE To evaluate the association of lymphovascular invasion (LVI) with oncologic outcomes of squamous cell carcinoma (SCC) of the urinary bladder following radical cystectomy (RC). PATIENTS AND METHODS We performed a retrospective analysis of 1,280 patients who underwent RC for invasive bladder cancer between 1997 and 2003 in Mansoura, Egypt. Only patients with pure urothelial carcinoma of the bladder (UCB) or SCC pathology were included. Using multivariate Cox regression analyses and Kaplan-Meier analyses, prognostic significance of LVI in disease-free survival and cancer-specific survival was evaluated for patients with UCB and SCC. RESULTS Our cohort included 519 (59%) patients with UCB and 360 (41%) with SCC. Median patient age and follow-up were 55 years (20-87) and 64 months (0-128), respectively. Median number of lymph nodes (LN) retrieved was 19 (4-70). LVI was present in 288 (32.8%) patients (241 [46.4%] UCB vs. 47 [13.1%] SCC; P<0.001). LVI was an independent predictor of oncologic outcomes in both UCB and SCC groups; however, LVI had more prognostic significance in SCC. LN negative, LVI positive (LVI+/LN-) patients with SCC had higher risk of recurrence and cancer-specific mortality compared to LN positive, LVI negative (LVI-/LN+) patients with SCC (hazard ratio = 2.8 vs. 1.9 and hazard ratio = 3.6 vs. 2.2, respectively). CONCLUSION The presence of LVI is an independent predictor of poor oncologic outcomes after RC and had greater prognostic significance in patients with SCC compared to UCB.

PD42-09 CLINICAL COMPARISON OF CONVENTIONAL AND MOBILE ENDOCKSCOPE VIDEOCYSTOSCOPY USING AN AIR OR FLUID IRRIGANT

INTRODUCTION AND OBJECTIVES: Conventional videocystoscopy (CVC) requires sterile fluid irrigant, a high power external light source, a cystoscope, and a video monitor/camera system. The high equipment cost makes the widespread use of videocystoscopy prohibitive in underserved populations. We developed the Endockscope (ES), a novel and affordable videocystoscopy system, which utilizes a mobile phone for image display and a solar-rechargeable LED-flashlight as a light source and sought to compare the resultant endoscopic view with CVC in real clinical settings using both air and fluid as an irrigant. METHODS: Patients scheduled for in-office videocystoscopy for either bladder tumor surveillance or stent removal were considered eligible. Each patient first received CVC visualizing the bladder in a systematic manner using normal saline, a video monitor, external light source, and flexible fiberoptic cystoscope. Without removing the cystoscope, the ES was attached to the cystoscope using the iPhone 6S as a video monitor/camera and the flashlight as the light source. The cystoscopy was then repeated with fluid irrigant (Endockscope-Fluid, ES-F) and then the fluid was drained and replaced with the same volume of air (Endockscope-Air, ES-A). All three exams were recorded and then sent to 11 expert endourologists for grading on a variety of metrics (1-5 scale, 5 being best): image quality/resolution, brightness, color quality, sharpness, overall quality, and whether the video was acceptable for diagnostic purposes (yes/no). RESULTS: Ten patients underwent CVC, ES-F, and ES-A cystoscopy (J.L. or R.V.C.). Six of the 10 patients had CVC videos deemed acceptable for diagnostic purposes and thus were compared with ES. The CVC videos scored higher on every metric relative to both the ES-F and ES-A (p < 0.05). The largest difference noted between CVC and ES videos was brightness (p < 0.0001). ES-F videos trended toward higher ratings than ES-A on all metrics, although none reached statistical significance (p > 0.05); 52% and 44% of the ES-F and ES-A videos, respectively, were considered acceptable for diagnostic purposes (p 1⁄4 0.384). CONCLUSIONS: The Endockscope mobile cystoscopy system using a fluid irrigant may be a reasonable option in settings where electricity or access to conventional videocystoscopic equipment is unavailable.

MP52-17 EVALUATION AND COMPARISON OF CONTEMPORARY ENERGY-BASED SURGICAL VESSEL SEALING DEVICES

Cook (4.15mg) and lowest with Bard Max-Core (2.60mg, p<0.0001). Needle tip deflection varied by needle and by medium (p<0.0001 for all media; Figure 1). Deflection in all 4 media was lowest with BioPince and highest with TSK. The noise level ranged from 100.62dB for Bard MaxCore to 107.24dB for TSK (p<0.0001)a sound pressure difference of approximately 2.2 times. No difference in ultrasound visibility was detected. Of note, in the present study, the BioPince needle did not exhibit “zero biopsy”, as reported by patient studies. CONCLUSIONS: Six core biopsy needles demonstrate significant differences in quantitative measures of overall sample quality, needle tip deflection, and noise level. These can be used for needle selection in the clinical setting.

Predictors of Oncologic Outcomes After Treatment of Urothelial Cancer

Despite modern advances in surgical procedures, morbidity and mortality rates remain unsatisfactory for patients treated for bladder cancer (BC) or upper tract urothelial cancer (UTUC). Conventional prognostic tools such as tumor grade, stage, and lymph node involvement are important predictors of oncologic outcomes, but additional prognostic factors have been established in recent years and may lead to improved treatment decision-making and oncologic outcomes for patients with BC or UTUC. The integration of several clinico-pathological and molecular biomarkers into multivariable prognostic models or nomograms has been shown to provide more accurate prognoses than grade and stage alone in patients with UC. In this chapter, we review the current prognostic factors for BC and UTUC, giving particular attention to clinico-pathological factors shown to be independent predictors of oncologic outcomes.