Majid Mirzazadeh

Bladder Tissue Engineering

The bladder can lose the ability to store and empty effectively as a result of numerous conditions. When conservative methods to maximize patient safety and quality of life fail, surgical reconstruction of the bladder is usually considered. Augmentation cystoplasty can be performed with the use of the small bowel, large bowel, or less often, stomach. An alternative approach, tissue engineering, identifies the bodys own potential for regeneration and supports this propensity with appropriate raw materials and growth factors so that the bodys original structure and function may be restored. Tissue engineering can involve the use of a scaffold or matrix alone or of cell-seeded matrices. Harvesting cells and culturing them has become an important tool in tissue engineering. Multiple possibilities for sources of cells have been investigated, including stem cells and differentiated cells from organs other than the bladder; however, to date, autologous bladder cells remain the gold standard for culture and seeding.

Effects of drinking water quality on urinary parameters in men with and without urinary tract stones.

OBJECTIVE There is some controversy regarding the impact of water hardness on stone risk. Our study addresses this issue in a controlled setting. MATERIAL AND METHODS Fifteen stone-former (SF) and 14 non-stone-former (NSF) males participated in this study in 3 intervals of 2 days each. Subjects collected a 24-hour urine sample while consuming a self-selected diet. They were then administered controlled diets. During the first 2 days, patients consumed water of minimal hardness (WMH), followed by tap water (TW) with moderate hardness on days 3 and 4, and mineral water (MW) on the final 2 days. Calcium (Ca), phosphorus, uric acid, oxalate, citrate, magnesium (Mg), sodium, potassium, and creatinine (Cr) content were measured in 24-hour urine samples on days 2, 4, and 6. RESULTS Differences in water hardness and analytes were statistically significant among the different water types (P < .05). Urinary output in both groups increased during intervention with all 3 varieties of water (P < .05). Specific gravity of urine decreased in both groups drinking WMH and TW (P < .05) but not with MW. Mg/g Cr level was higher in NSF at baseline (P < .01), WMH (P < .05), and TW (P < .05). With the increase in drinking water hardness, Ca/g Cr ratio increased in SF but not in NSF (P < .05). CONCLUSIONS NSF had significantly higher urinary Mg/g Cr excretion rate before intervention than SF (P < .01). Increasing drinking water hardness while controlling for all other factors increased Ca/g Cr ratio in SF, rendering them at least theoretically more inclined to stone formation.

Kidney transplantation, bioengineering and regeneration: an originally immunology-based discipline destined to transition towards ad hoc organ manufacturing and repair

ABSTRACT Kidney transplantation (KT), as a modality of renal replacement therapy (RRT), has been shown to be both economically and functionally superior to dialysis for the treatment of end-stage renal disease (ESRD). Progress in KT is limited by two major barriers: a) a chronic and burgeoning shortage of transplantable organs and b) the need for chronic immunosuppression following transplantation. Although ground-breaking advances in transplant immunology have improved patient survival and graft durability, a new pathway of innovation is needed in order to overcome current obstacles. Regenerative medicine (RM) holds the potential to shift the paradigm in RRT, through organ bioengineering. Manufactured organs represent a potentially inexhaustible source of transplantable grafts that would bypass the need for immunosuppressive drugs by using autologous cells to repopulate extracellular matrix (ECM) scaffolds. This overview discusses the current status of renal transplantation while reviewing the most promising innovations in RM therapy as applied to RRT.

Pheochromocytoma diagnosed pathologically with previous negative serum markers.

Patients presenting with adrenal masses require workup with catecholamine or metabolite measurements to rule out pheochromocytoma. There is a select portion of patients with marker negative pheochromocytoma. The aim of this study is to compare patient characteristics and presentations between marker positive and marker negative tumors.

Infrequent Reservoir‐Related Complications of Urologic Prosthetics: A Case Series and Literature Review

Abstract Introduction and Aim Complications related to inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) reservoirs are rare, potentially life threatening, and poorly described in the literature. As more devices are implanted, the incidence of reservoir‐related complications may increase, and it will be important to recognize the relevant signs and symptoms. Methods and Main Outcome Measures We present a case series of reservoir‐related complications presenting to our institution for treatment. We also reviewed all accounts of reservoir‐related complications within the urologic literature Results Three cases of reservoir‐related complications are presented. Case 1 involves erosion of an intact AUS reservoir into the cecum of a patient with a history of myelomeningocele and bladder augmentation. Case 2 involves an IPP reservoir causing vascular compression, resulting in open exploration and repositioning of the reservoir. Case 3 involves intraperitoneal migration of a retained IPP reservoir to a subhepatic area, which was then removed laparoscopically. Literature review yielded descriptions of eight cases of intestinal complications, five cases of vascular complications, but zero reports of migration to a subhepatic area. Other notable complications include 20 reported cases of reservoir erosion into the bladder and inguinal herniation of the reservoir. Conclusion Complications involving urologic prosthesis reservoirs, although rare, can have serious implications for patients. A high index of suspicion and familiarity with treatment options is required in order to allow timely diagnosis and appropriate treatment. Patients with prior major abdominal surgeries seem to be more prone to intestinal complications of reservoirs and warrant special concern. Cui T, Terlecki R, and Mirzazadeh M. Infrequent reservoir‐related complications of urologic prosthetics: A case series and literature review. Sex Med 2015;3:334–338.

Gas-containing Renal Stones: Findings From Five Consecutive Patients

OBJECTIVE To describe the clinical course, microbiology, and metabolic findings of 5 patients presenting to our institution with gas-containing renal stones. MATERIALS AND METHODS During a 20-month period beginning in 2009, 5 patients were identified by computed tomography scanning to harbor gas-containing renal calculi. Despite similar imaging and referral practice patterns, no such cases had been seen at our institution in the preceding 20 years. The records of these patients were reviewed to better characterize this unique condition. RESULTS All 5 subjects were premenopausal women. One patient presented with urosepsis and 4 presented with flank pain. All had urinary tract infections, and Escherichia coli was isolated from a voided urine specimen in 3. Stone culture was positive in 2 and was concordant with the voided specimen in 1. The stones were solitary in 4 and multiple in 1 patient. All the stones were composed of calcium phosphate. Of the 5 patients, 3 had pure calcium phosphate stones and 2 had stones with calcium oxalate monohydrate components. Also, 3 subjects had diabetes mellitus, 3 had hypertension, and 1 had a history of gout. Two subjects underwent 24-hour urine metabolic testing, and abnormalities were identified in both. All patients were rendered stone free: 4 with percutaneous nephrostolithotomy and 1 using robotic pyelolithotomy. CONCLUSION Gas-containing renal stones are rare but might be increasing in prevalence. The pathophysiology is unknown but is most likely influenced by a combination of metabolic and infectious factors.

Diagnostic accuracy of nucleic acid amplification tests (NAATs) in urine for genitourinary tuberculosis: a systematic review and meta-analysis

BackgroundGenitourinary tuberculosis is the third most common form of extrapulmonary tuberculosis. Diagnosis is difficult because of unspecific clinical manifestations and low accuracy of conventional tests. Unfortunately, the delayed diagnosis impacts the urinary tract severely. Nucleic acid amplification tests yield fast results, and among these, new technologies can also detect drug resistance. There is lack of consensus regarding the use of these tests in genitourinary tuberculosis; we therefore aimed to assess the accuracy of nucleic acid amplification tests in the diagnosis of genitourinary tuberculosis and to evaluate the heterogeneity between studies.MethodsWe did a systematic review and meta-analysis of research articles comparing the accuracy of a reference standard and a nucleic acid amplification test for diagnosis of urinary tract tuberculosis. We searched Medline, EMBASE, Web of Science, LILACS, Cochrane Library, and Scopus for articles published between Jan 1, 1990, and Apr 14, 2016. Two investigators identified eligible articles and extracted data for individual study sites. We analyzed data in groups with the same index test. Then, we generated pooled summary estimates (95% CIs) for sensitivity and specificity by use of random-effects meta-analysis when studies were not heterogeneous.ResultsWe identified eleven relevant studies from ten articles, giving information on PCR, LCR and Xpert MTB/RIF tests. All PCR studies were “in-house” tests, with different gene targets and had several quality concerns therefore we did not proceed with a pooled analysis. Only one study used LCR. Xpert studies were of good quality and not heterogeneous, pooled sensitivity was 0·87 (0·66–0·96) and specificity was 0·91 (0·84–0·95).ConclusionPCR studies were highly heterogeneous. Among Xpert MTB/RIF studies, specificity was favorable with an acceptable confidence interval, however new studies can update meta-analysis and get more precise estimates. Further high-quality studies are urgently needed to improve diagnosis of genitourinary tuberculosis.Protocol registrationPROSPERO CRD42016039020.

Short-term complications associated with the use of transvaginal mesh in pelvic floor reconstructive surgery: Results from a multi-institutional prospectively maintained dataset

Vaginal reconstructive surgery can be performed with or without mesh. We sought to determine comparative rates of perioperative complications of native tissue versus vaginal mesh repairs for pelvic organ prolapse.

Complete duplication of collecting system in a horseshoe kidney presenting with recurrent urinary tract infections: report of an exceedingly rare congenital anomaly and review of literature.

We report the fifth case in the English literature of a horseshoe kidney with a complete ureteral duplication. Our case is unique in that the previous four cases occurred in the presence of a ureterocele, whereas our patient lacked this anomaly. Further, our patient was managed conservatively, whereas the previous four patients were managed with surgery.

MP23-20 PROBIOTICS IN RECURRENT UTIS: COLLECTIVE INFORMATION ON COMMERCIALLY AVAILABLE PRODUCTS

• Probiotics consist of live micro-organisms that can improve patient wellbeing. The mechanism of action of probiotics includes mucosal barrier maintenance, resistance to colonization, and inactivating bacterial toxins and virulence factors1 • Emergence of multi-drug resistant organisms has stimulated interest in non-antibiotic methods for prevention of urinary tract infection (UTI), such as probiotics2 • Probiotics have become increasingly popular. Between 2007 and 2012, the number of Americans taking a probiotic supplement increased four-fold to nearly 3 million adults and 294,000 children for different indications including UTI