Preventing Biofilm Formation and Encrustation on Urinary Implants: (Bio)molecular and Physical Research Approaches

Stents and catheters are used to facilitate urine drainage within the urinary system. When such sterile implants are inserted into the urinary tract, ions, macromolecules and bacteria from urine, blood or underlying tissues accumulate on their surface. We presented a brief but comprehensive overview of future research strategies in the prevention of urinary device encrustation with an emphasis on biodegradability, molecular, microbiological and physical research approaches. The large and strongly associated field of stent coatings and tissue engineering is outlined elsewhere in this book. There is still plenty of room for future investigations in the fields of material science, surface science, and biomedical engineering to improve and create the most effective urinary implants. In an era where material science, robotics and artificial intelligence have undergone great progress, futuristic ideas may become a reality. These ideas include the creation of multifunctional programmable intelligent urinary implants (core and surface) capable to adapt to the complex biological and physiological environment through sensing or by algorithms from artificial intelligence included in the implant. Urinary implants are at the crossroads of several scientific disciplines, and progress will only be achieved if scientists and physicians collaborate using basic and applied scientific approaches

Bradyzoite pseudokinase 1 is crucial for efficient oral infectivity of the Toxoplasma gondii tissue cyst.

The tissue cyst formed by the bradyzoite stage of Toxoplasma gondii is essential for persistent infection of the host and oral transmission. Bradyzoite pseudokinase 1 (BPK1) is a component of the cyst wall, but nothing has previously been known about its function. Here, we show that immunoprecipitation of BPK1 from in vitro bradyzoite cultures, 4 days postinfection, identifies at least four associating proteins: MAG1, MCP4, GRA8, and GRA9. To determine the role of BPK1, a strain of Toxoplasma was generated with the bpk1 locus deleted. This BPK1 knockout strain (Δbpk1) was investigated in vitro and in vivo. No defect was found in terms of in vitro cyst formation and no difference in pathogenesis or cyst burden 4 weeks postinfection (wpi) was detected after intraperitoneal (i.p.) infection with Δbpk1 tachyzoites, although the Δbpk1 cysts were significantly smaller than parental or BPK1-complemented strains at 8 wpi. Pepsin-acid treatment of 4 wpi in vivo cysts revealed that Δbpk1 parasites are significantly more sensitive to this treatment than the parental and complemented strains. Consistent with this, 4 wpi Δbpk1 cysts showed reduced ability to cause oral infection compared to the parental and complemented strains. Together, these data reveal that BPK1 plays a crucial role in the in vivo development and infectivity of Toxoplasma cysts

Ureterolithiasis after Cohen re-implantation – case report

BACKGROUND: In the past decades, the widespread use of cross-trigonal ureteral reimplants for the treatment of children with vesicoureteral reflux has resulted in a large population of patients with transversely lying ureters. As this population gets older they will consequently be entering an age group at higher risk for stone and urothelial cancer formation. If ureteroscopy becomes necessary, the transverse position of the ureter makes ureteric access often impossible. CASE PRESENTATION: We present the case of a young man who not only suffered from urolithiasis due to hyperparathyroidism, but also further jeopardized his treatment by omitting the fact that as a child he underwent Cohen reimplantation of the right ureter. CONCLUSIONS: This case illustrates the particular difficulties the endoscopist may face in this group of patients. Patients with difficult ureteric access, abnormal anatomy, or those with known cross-trigonal ureteric reimplantations should be managed in a specialised endourology unit

Early rare recurrence of a huge renal solitary fibrous tumor: Case report and review of literature

Solitary fibrous tumor (SFT) is a spindle cell neoplasm of mesenchymal origin. First reported in 1931, the pleura is the most common localization of SFT, and it’s exceptionally rare in the kidney. Overall, it represents less than 2% of all soft tissue tumors. In most cases, renal SFT (rSFT) presents with hematuria, flank pain, and a palpable mass. To our knowledge, less than 112 cases of rSFT have been reported. We report a case of rSFT of a 30-year-old male thought to be a renal cell carcinoma (RCC). Radical nephrectomy (RN) was done to remove a large right-sided mass invading the inferior vena cava. Immunohistochemistry confirmed the diagnosis of SFT showing positivity for CD34, CD99, and Bcl-2 protein, with no staining for cytokeratin. A post-operative CT (15 months) showed tumor recurrence in the renal compartment with huge inferior vena cava thrombus extending to the external iliac veins. With this case, we illustrate and highlight the importance of this diagnosis because of the uncertain biological behavior and prognosis of these tumors

Metastatic appendiceal adenocarcinoma presenting late as epididymo-orchitis: a case report and review of literature

BACKGROUND: Whereas testicular metastases are in themselves a rare entity, testicular secondaries from an appendiceal carcinoma have not yet been described. The case also illustrates the diagnostic dilemma of a tumour presenting as epididymo-orchitis. CASE PRESENTATION: The authors present a case of an appendiceal carcinoma that, two years after radical therapy, manifested as a secondary in the testis. It was misdiagnosed as an epididymo-orchitis and was only revealed through histology. CONCLUSIONS: Practitioners need to remember that long-standing testicular inflammation may result form secondary tumours. Even "exotic" primary tumours in the medical history of the patient must give rise to an increased suspicion threshold

Endovascular covered stenting for the management of post-percutaneous nephrolithotomy renal pseudoaneurysm: a case report

<p>Abstract</p> <p>Introduction</p> <p>Intrarenal pseudoaneurysm is a rare, yet clinically significant, complication of percutaneous nephrolithotomy. A high index of clinical suspicion is necessary in order to recognize pseudoaneurysm as the cause of delayed bleeding after percutaneous nephrolithotomy and angiography confirms the diagnosis which allows endovascular management.</p> <p>Case presentation</p> <p>We present a case of a 65-year old Caucasian woman who underwent percutaneous nephrolithotomy in the supine position for a two centimetre renal calculus. The postoperative course was complicated by persistent bleeding due to a renal pseudoaneurysm. The vascular lesion was successfully managed by endovascular exclusion through the use of a covered stent graft. We report the first successful use of this method for the management of iatrogenic pseudoaneurysm in a branch of the left renal artery and we focus on the imaging findings, technical details, advantages and limitations of this technique.</p> <p>Conclusion</p> <p>As a result of its high efficacy, interventional radiology has largely replaced open surgery for the management of renal pseudoaneurysm related to percutaneous nephrolithotomy. Recent technical advancements have allowed the use of covered stent grafts as an alternative to embolisation for the angiographic management of visceral artery pseudoaneurysm located in other organs. This novel technique allows the endovascular exclusion of the pseudoaneurysm, without compromising arterial supply to the end-structures - an advantage of critical importance in organs supplied by segmental arteries - in the absence of collateral vasculature, such as the kidney.</p