Re: Using the T11 Vertebra to Minimise the CT-KUB Scan Field.

available at https://pubmed.ncbi.nlm.nih.gov/32208971 Editorial Comment: Using the center of the T11 vertebral body as the superior extent of computerized tomography of the abdomen and pelvis uniformly resulted in total visualization of both kidneys and limited the field of radiation. The targeted goal was less than 15% of the scan length above the top of the kidneys. The authors achieved a mean of 10.6%. They did not provide measurements of the amount of ionized radiation (ie millisieverts). However, I suspect that the amount would be lower using this technique. Dean G. Assimos, MD Suggested Reading Fulgham PF, Assimos DG, Pearle MS et al: Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol 2013; 189: 1203. Yecies T, Bandari J, Fam M et al: Risk of radiation from computerized tomography urography in the evaluation of asymptomatic microscopic hematuria. J Urol 2018; 200: 967. Saltzman AF, Carrasco A Jr, Weinman J et al: Initial imaging for pediatric renal tumors: an opportunity for improvement. J Urol 2018; 199: 1330. Sternberg KM and Littenberg B: Trends in imaging use for the evaluation and followup of kidney stone disease: a single center experience. J Urol 2017; 198: 383. Chen TT, Wang C, Ferrandino MN et al: Radiation exposure during the evaluation and management of nephrolithiasis. J Urol 2015; 194: 878. Neisius A, Wang AJ, Wang C et al: Radiation exposure in urology: a genitourinary catalogue for diagnostic imaging. J Urol 2013; 190: 2117. Heldt JP, Smith JC, Anderson KM et al: Ureteral calculi detection using low dose computerized tomography protocols is compromised in overweight and underweight patients. J Urol 2012; 188: 124. Re: Risk of Kidney Stone among Workers Exposed to High Occupational Heat StressdA Case Study from Southern Indian Steel Industry V. Venugopal, P. K. Latha, R. Shanmugam, M. Krishnamoorthy, K. Srinivasan, K. Perumal and J. S. Chinnadurai Department of Environmental Health Engineering and Department of Physiology, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, India Sci Total Environ 2020; 722: 137619. doi: 10.1016/j.scitotenv.2020.137619 Abstract available at https://pubmed.ncbi.nlm.nih.gov/32197155available at https://pubmed.ncbi.nlm.nih.gov/32197155 Editorial Comment: This study demonstrates the environmental contribution to kidney stone risk. These investigators found that steel workers exposed to elevated temperatures had higher levels of strain, including increases in core body temperature, urinary specific gravity and sweat rate. A higher proportion of the heat exposed cohort manifested renal related symptoms, including flank/low back discomfort and lower urinary tract symptoms. Those with urinary tract symptoms were evaluated with renal ultrasonography, and the heat exposed cohort had a UROLITHIASIS/ENDOUROLOGY 873 Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. significantly higher prevalence of nephrolithiasis. These results indicate that proactive programs should be established to ensure that individuals exposed to high temperatures at work receive adequate hydration. This practice would have both health related and economic benefits. Dean G. Assimos, MD Suggested Reading Borghi L, Meschi T, Amato F et al: Hot occupation and nephrolithiasis. J Urol 1993; 150: 1757. Borghi L, Meschi T, Amato F et al: Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol 1996; 155: 839. Ferraro PM, Ticinesi A, Meschi T et al: Short-term changes in urinary relative supersaturation predict recurrence of kidney stones: a tool to guide preventive measures in urolithiasis. J Urol 2018; 200: 1082. Pearle MS, Goldfarb DS, Assimos DG et al: Medical management of kidney stones: AUA Guideline. J Urol 2014; 192: 316. Re: Prospective Randomized Trial Comparing the Safety and Clarity of Water versus Saline Irrigant in Ureteroscopy F. Pirani, S. S. Makhani, F. Y. Kim, A. H. Lay, C. B. Cimmino, L. Hartsell, A. Spence, V. A. Master and K. Ogan Medical College of Georgia, Augusta University, Augusta, School of Medicine, Mercer University, Macon and Department of Urology, Emory University School of Medicine, Atlanta, Georgia Eur Urol Focus 2020; Epub ahead of print. doi: 10.1016/j.euf.2020.02.009 Abstract available at https://pubmed.ncbi.nlm.nih.gov/32146123available at https://pubmed.ncbi.nlm.nih.gov/32146123 Editorial Comment: The authors report that using water in uncomplicated ureteroscopy is safe and provides better visualization as indexed by a measurement of turbidity. However, I would not use this as a platform for integrating this approach into practice. The duration of cases in this series was short. Complex ureteroscopic procedures (longer duration, larger stone burdens) are now being commonly undertaken, and the risk of hyponatremia may be higher in such cases. The visualization provided with saline irrigation has typically been more than adequate over the years, especially with the integration of digital endoscopy. Visualization may become an issue when there is bleeding, especially when working in the renal collecting system. This event may be due to violation of the papillary epithelium or urothelium, and thus fluid absorption could occur. Bleeding typically subsides and visualization improves in such cases, although if it does not, the safest approach is to place a stent and come back another day! Dean G. Assimos, MD Suggested Reading Assimos D, Krambeck A, Miller NL et al: Surgical management of stones: American Urological Association/Endourological Society Guideline, part II. J Urol 2016; 196: 1161. Hermanns T, Grossmann NC, Wettstein MS et al: Absorption of irrigation fluid occurs frequently during high power 532 nm laser vaporization of the prostate. J Urol 2015; 193: 211. Collins JW, Macdermott S, Bradbrook RA et al: The effect of the choice of irrigation fluid on cardiac stress during transurethral resection of the prostate: a comparison between 1.5% glycine and 5% glucose. J Urol 2007; 177: 1369. 874 UROLITHIASIS/ENDOUROLOGY Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.