Faculty Bibliography

Tamm-Horsfall protein (THP) is the most abundant protein in urine, yet its function remains incompletely understood. It has been hypothesized that THP contributes to the maintenance of urinary homeostasis. We report a case of a 71-year-old male with a history of renal cell carcinoma treated with partial nephrectomy in 2017. He represented 8 years later with an enlarging, enhancing renal mass concerning for recurrence. A radical nephrectomy was performed and revealed a benign specimen with a positive PAS stain, consistent with THP. To our knowledge this is the first report of THP deposition in the renal parenchyma after partial nephrectomy.

INTRODUCTION/BACKGROUND:Free radical-mediated oxidative renal tubular injury secondary to hyperoxaluria is a proposed mechanism in the formation of calcium oxalate stones. Vitamin E, an important physiologic antioxidant, has been shown in rat models to prevent calcium oxalate crystal deposition. Our objective was to determine if low dietary vitamin E intake was associated with a higher incidence of stones. MATERIALS AND METHODS/METHODS:We analyzed data from the 2017 to 2020 National Health and Nutrition Examination Survey, a nationally representative sample (n = 7,707). A multivariable logistic regression model was used to assess the association between elevated dietary vitamin E intake (≥ 15 mg/day) and nephrolithiasis controlling for key demographic variables: water and nutrient intake (sodium, calcium, vitamin C), and diabetes mellitus. RESULTS:The incidence of nephrolithiasis was 1.66% (1.38% - 1.95%). In patients consuming < 15 mg/day vitamin E, the incidence was 1.8% compared to 0.8% in patients with vitamin E intake ≥ 15 mg/day (p = 0.024). In adjusted models, participants with low vitamin E intake had a significantly higher odds of reporting stone passage (aOR = 2.83, 95% CI (1.07 - 7.5)). CONCLUSION/CONCLUSIONS:We found that low vitamin E intake is associated with a > 2.5× greater odds of stone passage. These data are consistent with animal models suggesting that vitamin E may play an important protective role in the pathogenesis of calcium oxalate stone formation. This is the first study assessing the relationship between vitamin E intake and nephrolithiasis in humans. Future investigation of vitamin E supplementation in stone formers may help further determine if vitamin E is useful in the management of calcium oxalate stones.

OBJECTIVE:To measure lithogenic changes during pregnancy in patients on a standardized diet without a prior history of nephrolithiasis. METHODS:IRB approval was obtained. The metabolic needs of pregnant participants were determined, and standardized diet administered with Boost shakes and unlimited water. 24-hour urine collections were obtained during the third trimester, post-partum, and post-lactation. Subjects remained on the controlled diet for 24-hour prior to and during the collection. Standard statistical analysis was performed. RESULTS:Of 18 patients, 6 had a de novo stone event during pregnancy. Of these, 83% were composed of calcium phosphate. Stone events with calcium phosphate presented later than calcium oxalate. Stone-formers had an intra-partum body mass index greater than non-stone formers (33.1 vs 26.7, P <.05). All participants had hypercalciuria, but stone-formers were found to have a nearly 2X greater urine calcium compared to non-stone formers on their controlled diet (392.1 vs 205.9, P <.05). Post-partum, we observed a decrease in urine calcium, citrate, pH, and supersaturation of calcium oxalate and phosphate (P <.05). CONCLUSION/CONCLUSIONS:This is the first study to identify lithogenic changes during pregnancy in de novo stone formers on a standardized diet. We show that stone-formers have primarily calcium phosphate stones. They also have an elevated body mass index and are significantly more hypercalciuric without other demonstratable lithogenic differences compared to non-stone formers. Post-partum, we demonstrate reduction in intra-partum lithogenicity that may mitigate stone risk. These data suggest an underlying mechanism exists in stone formers that increases urine calcium above what would be expected in gestational hypercalciuria.

BACKGROUND:Female sexual dysfunction (FSD) is a prevalent and multifaceted condition affecting women's sexual well-being. This randomized controlled trial aimed to evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS) compared to a validated sham control in the treatment of FSD. METHODS:We conducted a single-center randomized controlled trial. Participants with FSD were recruited and randomly assigned at a 1:1 allocation ratio to either PTNS or a validated sham control using transcutaneous nerve stimulation (TENS). Treatment was performed through weekly 30-min session for 12 weeks total. Sexual function was assessed at baseline, 6 weeks, and 12 weeks primarily using the Female Sexual Function Index (FSFI) questionnaire. Urogenital distress inventory-6 was collected to evaluate for any baseline urinary incontinence/voiding dysfunction. Linear mixed-effect models for longitudinal data were used to compare FSFI scores across different time points. Statistical analysis was performed using SAS 9.4 (SAS Institute Inc. Cary, NC). RESULTS:In total, 34 PTNS and 31 TENS subjects were included in our final analysis. Overall, 48% (16/34) of PTNS subjects versus 29% (11/33) of TENS subjects were no longer at risk for FSD (FSFI > 26.55) after 12 weekly treatments. Both PTNS and TENS subjects demonstrated similar improvements in FSFI total scores after 12 weeks of treatments. Interestingly, patients who did not present with baseline urogenital distress symptoms reported a statistically significant larger improvement in sexual satisfaction after PTNS treatments as compared to placebo (p = 0.017). CONCLUSION/CONCLUSIONS:This study demonstrated a sustained efficacy of PTNS in improving sexual function. Specifically, patients who did not have coexisting urinary dysfunction reported significant improvement in sexual satisfaction after PTNS. Our study suggested that PTNS may have a direct neuromodulation effect on sexual dysfunction and may hold promise as a treatment modality for FSD.

PURPOSE/OBJECTIVE:Overactive bladder (OAB) is a prevalent condition that can have a significant impact on quality of life. Sacral neuromodulation (SNM) is proven as an effective treatment option for OAB patients. Rechargeable devices have gained popularity in recent years. However, there is a paucity of data investigating revision rates for rechargeable SNM devices and associated impacting factors. MATERIALS AND METHODS/METHODS:We conducted a retrospective cohort study to investigate the revision rates of SNM devices in patients diagnosed with OAB. Patients who underwent implantation of rechargeable or non-rechargeable SNM devices at our institution between January 2019 and June 2023 were included. Revision events, reasons for revisions, and patient demographics were analyzed and compared between the device groups. RESULTS:The study included 246 patients. One hundred fifty received rechargeable SNM devices and 96 received non-rechargeable devices. Revision rates were significantly different between the two groups, with 34% of patients in the rechargeable device group requiring revisions compared to 13.5% in the non-rechargeable group (p < 0.001). The most common reasons for revision in the rechargeable group included difficulty charging (35.3%) and reduction of symptom improvement (23.5%). Having a rechargeable device resulted in a significantly higher probability of requiring a revision over time compared to non-rechargeable (p < 0.001). CONCLUSION/CONCLUSIONS:Our study demonstrated that patients who received rechargeable SNM devices were more likely to require revision. Factors such as device malfunction or difficulties connecting to the device may contribute to the higher revision rates. Further studies are needed to elucidate factors affecting revision rates in SNM devices.

OBJECTIVE/UNASSIGNED:Obsessive-compulsive disorder (OCD) is a chronic condition in which impaired inhibitory control and excessive error monitoring may contribute to the maintenance of obsessions and compulsions. This mega-analysis investigates neural activation during response inhibition and error processing using adult and pediatric data from the ENIGMA-OCD consortium and the ABCD study. METHODS/UNASSIGNED:Individual participant data was uniformly processed using HALFpipe to extract statistical maps for response inhibition and error processing contrasts. Bayesian multilevel models were used to assess regional and whole-brain effects of OCD, with additional analyses examining the association between the OCD clinical profile and task-related activation. RESULTS/UNASSIGNED:Across inhibitory control tasks, both individuals with OCD and control participants showed robust activation in regions implicated in response inhibition and error processing. During response inhibition, compared to controls, adults with OCD showed stronger somatomotor cortex activation, while children with OCD showed stronger occipital cortex activation. Children with likely OCD from the ABCD cohort showed reduced activity in the frontoparietal network in the anterior insula/frontal operculum region. During error processing, relative to controls, adults with OCD showed weaker activation in fronto-striatal regions, while children with OCD showed stronger activation in frontoparietal and attention networks. Greater OCD symptom severity was associated with weaker task-related activation in adults and stronger activation in children during response inhibition. CONCLUSION/UNASSIGNED:Case-control differences in brain activation during inhibitory control varied by age group and task contrast. Symptom severity emerged as the main clinical correlate of activation during inhibition, suggesting that inhibitory control deficits in OCD may be both state-dependent and developmentally specific.

OBJECTIVE/UNASSIGNED:Determine whether the quadratus lumborum block (QLB) is an effective adjunct to control postoperative pain during the first 24 hours after minimally invasive hysterectomy. METHODS/UNASSIGNED:Prospective cohort observational study of patients who underwent laparoscopic or robotic hysterectomy. Patients either received a QLB or did not. Initial postoperative pain scores were recorded in the postanesthesia recovery area using a numeric rating scale. Patients were then called to collect 24-hour scores and analgesic medication usage. The primary outcome was the 3-hour pain score. Secondary analysis evaluated use of analgesic medication. RESULTS/UNASSIGNED: = .384) in the QLB group. Opioid, acetaminophen, and ibuprofen usage was not significantly different between groups. CONCLUSION/UNASSIGNED:There was no significant pain difference between the no-QLB and QLB groups. Patients who received a QLB were more likely to receive pain medication 3 hours after surgery. Thus, the use of a QLB does not appear to be a suitable adjunct for postoperative pain.