Page 3 - CUA2019 Abstracts - Endourology

2019 CUA Abstracts

outcome was the development of ureteric stricture (confirmed with renal References
scan and diagnostic URS). Secondary outcomes were the persistence or 1. Holmgren K, Dalielson BG, Felsltrom B, et al. The relation
development of hydronephrosis at three months postoperatively and long- between urinary tract infections and stone composition in renal
term hydronephrosis (>6 months post-URS). stone formers. Scand J Urol Nephrol 1989;23:131-6. https://doi.
Results: A total of 236 patients were included in this retrospective series. org/10.3109/00365598909180827
No patients in the UAS group developed a stricture with a mean followup 2. Tasian GE, Jemielita T, Goldfarb DS, et al. Oral antibiotic exposure
of 21.7 months, while one patient in the no-UAS group developed a stric- and kidney stone disease. J Am Soc Nephrol 2018;29:1731-40.
ture at the site of an impacted ureteric stone. Postoperative hydronephrosis https://doi.org/10.1681/ASN.2017111213
was the same or worse three months after URS in four patients in each
group (3.3% of patients in the UAS group vs. 3.5% in the no-UAS group; MP-3.8
p=NS). All other cases of hydronephrosis at three months and at long-term
followup were caused by non-obstructing, unresolved hydronephrosis or Impact of a bacterial urinary infection isolate on calcium oxalate
residual stone fragments. crystal adherence to renal epithelial cells: Potential novel role
Conclusions: In our series of patients who underwent URS with a UAS, for osteopontin and zinc 2 2 1
1
no patients developed a ureteric stricture. The UAS provides surgeons Jennifer Bjazevic , Kait F. Al , Jaswanth Gorla , Hassan Razvi , Jeremy
1,2
with the ability to perform URS safely without added risk of postoperative P. Burton 2
1
hydronephrosis or strictures. Surgery, Western University, London, ON, Canada; Microbiology &
References Immunology, Western University, London, ON, Canada
1. Traxer O, Thomas A. Prospective evaluation and classification of Urology Care Foundation Research Scholar Award
ureteral wall injuries resulting from insertion of a ureteral access Introduction: Urinary pathogens have been implicated in the develop-
sheath during retrograde infra-renal surgery. J Urol 2013;189:580-4. ment of calcium stone disease; however, the mechanisms by which this
1
https://doi.org/10.1016/j.juro.2012.08.197 may occur have yet to be elucidated. Both osteopontin (OPN) and zinc
2. De Coninck V, Keller EX, Rodríguez-Monsalve M, et al. Systematic (Zn) are known to be involved in calcium oxalate (CaOx) urolithiasis
2-4
review of ureteral access sheaths: Facts and myths. BJU Int 2018;1 and have also been shown to play a role in bacterial pathogenesis. We
22:959-69. https://doi.org/10.1111/bju.14389 examined the impact of a non-urease-producing bacterium isolated from
a urinary tract infection, OPN, and Zn, on the adherence of CaOx crystals
to renal epithelial cells in an in vitro model.
MP-3.7 Methods: A crystal adherence assay was performed using HEK293 and
The effect of a bacterial urinary infection isolate and antibiotics MDCK renal epithelial cells grown to 90% confluence. Cells were
in a calcium urolithiasis model exposed to a non-urease-producing strain of Escherichia coli (UTI89) for
Jennifer Bjazevic , Kait F. Al , Jaswanth Gorla , Hassan Razvi , Jeremy 20 minutes at 37 °C (103 CFU), washed, and then incubated with CaOx
1
2
2
1
P. Burton 1,2 crystals (0.5 mg/mL) in artificial urine with or without the addition of
2
1 Surgery, Western University, London, ON, Canada; Microbiology & OPN (0.1 μg/mL) or zinc chloride (500 μg/mL), for an additional 20 min-
Immunology, Western University, London, ON, Canada utes. Unattached crystals were washed free and the adherence of CaOx
Urology Care Foundation Research Scholar Award crystals was determined with birefringence microscopy and quantified
Introduction: Urinary tract infections and antibiotic exposure with cip- by pixel intensity with MATLAB (2018).
rofloxacin and sulfonamides have shown an increased association with Results: Microscopy demonstrated live HEK/MDCK cells in all groups and
calcium-based (non-struvite) stone disease in large epidemiological stud- bacterial rods visible in cells treated with UTI89. In MDCK cells, signifi-
ies. In an attempt to elucidate the potential mechanism of action behind cantly increased crystal adherence was observed following UTI89 expo-
1,2
this phenomena, we examined the effect of a non-urease-producing bac- sure (p<0.001). Treatment with OPN and Zn were noted to have opposite
terium and antibiotics on the formation of calcium oxalate (CaOx) stones effects; crystal adherence following UTI89 exposure appeared decreased
in a Drosophila melanogaster (DM) fly model. with OPN and increased with Zn treatment (p<0.001). Examination of
Methods: DM flies were exposed to a non-urease-producing strain HEK293 cells showed similar trends; however, these results did not reach
of Escherichia coli (UTI89) and 0.1% sodium oxalate (n=30 per significance (Fig. 1).
group). Treatment with sub-minimum inhibitory concentrations of cip- Conclusions: Our results suggest that non-urease-producing E. coli may
rofloxacin (0.2 μg/mL) or trimethoprim-sulfamethoxazole (TMP-SMX, impact CaOx crystal adherence, and both Zn and OPN may play a novel
30/10 μg/mL) occurred on days 5–7. UTI89 inoculation was confirmed role in this process. Further investigation is required to delineate the
post-UTI89 exposure by culturing pulverized flies on lysogeny broth agar potential mechanisms by which urinary pathogens may alter crystal adher-
plates. Survival curve analysis and measured pixel intensity of stones ence and the precise role that both Zn and OPN may play in this process.
within dissected Malpighian tubules under birefringent microscopy was This paper has a figure, which may be viewed online at:
used to assess stone burden (MATLAB, 2018). https://2019.cua.events/webapp/lecture/96
Results: UTI89 inoculation was confirmed with a minimum concentration References
of 3x10 colony forming units/fly. DM treated with oxalate food had a 1. Holmgren K, Dalielson BG, Felsltrom B, et al. The relation
3
trend towards decreased survival over days 15–35; however, DM survival between urinary tract infections and stone composition in renal
was unaffected by UTI89 exposure. Preliminary results suggest that at day stone formers. Scand J Urol Nephrol 1989;23:131-6. https://doi.
7, exposure to UTI89 increased CaOx crystal production in Malpighian org/10.3109/00365598909180827
tubules (p=0.001), and treatment with both ciprofloxacin (p=0.012) and 2. Rittling S, Zetterberg C, Yagiz K, et al. Protective role of osteopontin
TMP-SMX (p=0.001) attenuated this effect (Fig. 1). in endodontic infection. Immunology 2009;129:105-14. https://doi.
Conclusions: Using the DM calcium urolithiasis model, our findings sug- org/10.1111/j.1365-2567.2009.03159.x
gest that CaOx stone formation may be impacted by both exposure to 3. Chi T, Kim MS, Lang S, et al. A drosophila model identifies a critical
both a non-urease-producing E. coli and treatment with the antibiotics role for zinc in mineralization for kidney stone disease PLoS One
ciprofloxacin and TMP-SMX. Further research is required to confirm these 2015;10:e0124150.
results and determine the potential mechanisms by which urinary patho- 4. Sabri M, Houle S, Dozois CM. Roles of the extra-intestinal patho-
gens and antibiotics may affect calcium-based stone formation. genic Escherichia coli ZnuACB and ZupT zinc transporters during
This paper has a figure, which may be viewed online at: urinary tract infection. Infect Immun 2009;77:1155-64. https://doi.
https://2019.cua.events/webapp/lecture/95 org/10.1128/IAI.01082-08
S98 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)