Brian H Eisner

Massachusetts General Hospital, Boston, Massachusetts, United States

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Publications (115)393.7 Total impact

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    ABSTRACT: To examine the changes in stone composition from 1990 to 2010. A retrospective review was performed of all renal and ureteral stones submitted from the state of Massachusetts to a single laboratory (Laboratory for Stone Research, Newton, MA) for the years 1990 and 2010. Stone composition was determined by infrared spectroscopy and/or polarizing microscopy. A total of 11,099 stones were evaluated (56.7 % from 1990, 43.3 % from 2010). From 1990 to 2010, the percentage of stones from females (i.e., female/male ratio) increased significantly (29.8 % in 1990 to 39.1 % in 2010, p < 0.001). Among women, from 1990 to 2010, there was a significant increase in stones which were >50 % uric acid (7.6-10.2 %, p < 0.005) and a significant decrease in struvite stones (7.8-3.0 %, p < 0.001). Among women with calcium stones, the % apatite per stone decreased significantly (20.0 vs. 11.7 %, p < 0.001). Among men, there were no changes in stones which were majority uric acid (11.7-10.8 %, p = 0.2). Among men with calcium stones, the % apatite per stone increased significantly (9.8 vs. 12.5 %, p < 0.001). Males also demonstrated a significant increase in both cystine (0.1-0.6 %, p < 0.001) and struvite stones (2.8-3.7 %, p = 0.02). The epidemiology of stone disease continues to evolve and appears to vary according to gender. While some of these findings may be related to population changes in body mass index and obesity, the etiology of others remains unclear.
    02/2015; 43(2). DOI:10.1007/s00240-015-0756-6
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    ABSTRACT: Ureteral stents are manufactured with an extraction string (string) tethered to the distal end, which facilitates removal after urologic surgery; however, the string may allow stent dislodgement. Herein we report the stent dislodgement rate in a multi-institutional series. Ureteroscopy cases from three academic endourology practices were retrospectively reviewed. Demographic and operative data were obtained, as were string use and stent dislodgement. Categorical variables were assessed with Fisher's exact test, and the student's T test was used to assess continuous variables. A total of 512 cases were performed and a string was used in 98 cases (19.1%). This included 41 females (41.8%) and 57 males (58.2%) with a string. Dislodgement occurred in 13 cases (10 women, 3 men). No dislodgements occurred when a string was not utilized. When stratified by gender, 5.3% of men and 24.4% of women with strings dislodged their stents (p =0.013). Women were more than four-fold more likely to dislodge their stents than men (RR 4.6, 95% CI 1.36 to 15.8, p = 0.01). Nearly 15% of patients who have a stent placed with a string will sustain stent dislodgement, and the majority of these will be women. We recommend considering the risks of dislodgement for each patient who undergoes ureteroscopy with stent placement, and consideration of string removal if the surgeon feels dislodgement could result in adverse events such as severe colic or obstruction. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of Urology 12/2014; 191(4). DOI:10.1016/j.juro.2014.12.087 · 3.75 Impact Factor
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    ABSTRACT: Purpose We examine kidney stone disease as a potential risk factor for chronic kidney disease, end stage kidney disease and treatment with dialysis. Materials and Methods The NHANES (National Health and Nutrition Examination Survey) 2007-2010 database was interrogated for patients with a history of kidney stones. Demographics and comorbid conditions including age, gender, body mass index, diabetes, hemoglobin A1c, hypertension, gout and smoking were also assessed. Multivariate analysis adjusting for patient demographics and comorbidities was performed to assess differences in the prevalence of chronic kidney disease and treatment with dialysis between the 2 groups. History of nephrolithiasis was assessed with the question, “Have you ever had kidney stones?” Chronic kidney disease was defined as an estimated glomerular filtration rate of less than 60 ml/minute/1.73 m2 and/or a urinary albumin-to-creatinine ratio greater than 30 mg/gm. Statistical calculations were performed using Stata® software with determinations of p values and 95% CI where appropriate. Results The study included an analysis of 5,971 NHANES participants for whom data on chronic kidney disease and kidney stones were available, of whom 521 reported a history of kidney stones. On multivariate analysis a history of kidney stones was associated with chronic kidney disease and treatment with dialysis (OR 1.50, 1.10–2.04, p = 0.013 and OR 2.37, 1.13–4.96, p = 0.025, respectively). This difference appeared to be driven by women, where a history of kidney stones was associated with a higher prevalence of chronic kidney disease (OR 1.76, 1.13–2.763, p = 0.016) and treatment with dialysis (OR 3.26, 1.48–7.16, p = 0.004). There was not a significant association between kidney stone history and chronic kidney disease or treatment with dialysis in men. Conclusions Kidney stone history is associated with an increased risk of chronic kidney disease and treatment with dialysis among women even after adjusting for comorbid conditions. Large scale prospective studies are needed to further characterize the relationship between nephrolithiasis and chronic kidney disease.
    The Journal of Urology 11/2014; 192(5):1440–1445. DOI:10.1016/j.juro.2014.05.117 · 3.75 Impact Factor
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    ABSTRACT: In the current study we examine the Hounsfield density of the renal papilla of stone-formers of all common stone subtypes to further understand the pathophysiology of stone formation. Computed tomography Hounsfield density measurements of a 0.2 cm(2) area of the renal papilla of patients with a single renal calyceal stone were performed and compared with controls (i.e. patients without a history of nephrolithaisis). Stone composition was determined from either stone passage or extraction during endoscopic procedures and the method was infrared spectroscopy and polarized microscopy. Hounsfield density measurements were made from the stone-bearing calyx as well as a single calyx from the upper, middle, and lower poles of each kidney. Mean hounsfield density of the renal papilla for control patients (i.e. those without stones) was 36.2 HU (SD 4.0). For patients with stones, the Hounsfield density of the renal papilla was significantly greater than controls for the stone bearing calyces, the non-stone-bearing calyces in the affected kidney, and the calyces in the contralateral non-stone-bearing kidney for all stone composition subtypes (range 48.4 - 61.3 HU, p < 0.001 for all). Patients with kidney stones, regardless of composition, exhibit the unique radiographic characteristic of increased Hounsfield density of the renal papilla. This is true for all calyces and for both kidneys for all stone formers with a single renal calyceal stone. This is radiographic evidence to support role of renal papillary deposits or plaques in the pathophysiology of stone formation. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of Urology 10/2014; DOI:10.1016/j.juro.2014.10.089 · 3.75 Impact Factor
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    Brian H Eisner, David S Goldfarb
    Journal of the American Society of Nephrology 08/2014; DOI:10.1681/ASN.2014060631 · 9.47 Impact Factor
  • Seth K Bechis, Brian H Eisner
    Evidence-Based Medicine 07/2014; DOI:10.1136/ebmed-2014-110017
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    ABSTRACT: Encrusted ureteral stents are a challenging endourologic problem that may require multiple procedures. We performed a multi-institutional review of percutaneous nephrolithotomy (PCNL) as primary treatment for encrusted stents. Patients were identified who underwent percutaneous nephrolithotomyPCNL for treatment of an encrusted ureteral stent. Retrospective review was performed to compile details of procedures and outcomes. Thirty-eight renal units underwent percutaneous nephrolithotomyPCNL for encrusted ureteral stents in 36 patients. Mean age was 47.1 years (±16.7) and female: male ratio was 15:21. Mean stent indwelling time prior to removal was 28.2 months (±27.8). Reason for long indwelling time was reported in 25 cases and included "patient unaware stent needed to be removed" (17 cases), pregnancy (2 cases), other comorbidities (3 cases), and patient was a prisonerincarceration (3 cases). In 3 cases, the stent had become encrusted within 3 months of placement. Mean operative time was 162 minutes (±71). There were no major intraoperative complications and no patients required blood transfusion. Litholopaxy was required for bladder coil encrustations in 22 cases (58%) and ureteroscopy with lithotripsy was required for encrustation of the ureteral portion of the stent in 13 cases (34.2%). Second look percutaneous procedures were required in 13 cases (34.2%). Stent was removed at the time of PCNL without need for concomitant or delayed ureteroscopy and/or cystolitholapaxy in 8 (21%). Ultimately, all stents were removed successfully. Patients were rendered radiographically stone-free in 24 cases (63%). In this multi-center review, PCNL is confirmed to be a safe and effective means of addressing the retained and encrusted ureteral stent. Percutaneous nephrolithotomyPCNL without ureteroscopy or litholopaxy was sufficient in a minority of cases (21%). Adjunctive endourologic modalities are often required, and the surgeon should anticipate the need for concomitant antegrade ureteroscopic laser lithotripsy and/or cystolitholapaxy. Although complete stent removal can be anticipated, residual fragments are not uncommon.
    Journal of endourology / Endourological Society 04/2014; 28(10). DOI:10.1089/end.2014.0004 · 1.75 Impact Factor
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    ABSTRACT: Introduction Flexible ureteroscopy (URS) is rapidly becoming a first-line therapy for many with renal and ureteral stones. However, the present understanding of treatment outcomes for patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones < 2 cm in order to better define clinical outcomes associated with this approach. Methods Adult patients with proximal ureteral calculi < 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded. Flexible URS, Holmium laser lithotripsy, and ureteral stent placement was performed. Ureteral access sheath use, laser settings, and other details of peri- and postoperative management were based on individual surgeon preference. Stone clearance was determined by renal ultrasound and KUB results at 4–6 weeks postoperatively. Results Of 71 patients, 44 (62%) were male and 27 (38%) were female. Mean age was 48.2 years. ASA score was 1 in 12 (16%), 2 in 41 (58%), 3 in 16 (23%), and 4 in 2 (3%). Mean BMI was 31.8 kg/m2. Mean stone size was 7.4mm (5-15). Mean surgical time was 60.3 minutes (15-148). Intraoperative complications occurred in 2 (2.8%) including mild ureteral trauma. Postoperative complications occurred in 6 (8.7%) including UTI (3), urinary retention (2), and flash pulmonary edema (1). The stone-free rate was 95%; for stones <1cm, the stone-free rate was 100%. Conclusions Flexible URS is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones < 2 cm.
    The Journal of Urology 04/2014; 193(1). DOI:10.1016/j.juro.2014.07.002 · 3.75 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e76. DOI:10.1016/j.juro.2014.02.349 · 3.75 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e272. DOI:10.1016/j.juro.2014.02.316 · 3.75 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e280. DOI:10.1016/j.juro.2014.02.379 · 3.75 Impact Factor
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    ABSTRACT: Objective: To evaluate the cost effectiveness of shock wave lithotripsy (SWL) versus ureteroscopic lithotripsy (URS) for patients with renal stones less than 1.5 cm in diameter. Methods: Patient age, stone diameter, stone location, and stone free status were recorded for patients treated with SWL or URS for renal stones under 1.5 cm in maximal diameter over a one year period. Institutional charges were obtained from in-house billing. A decision analysis model was constructed to compare the cost-effectiveness of SWL and URS and using our results and success rates for modeling. Three separate models were created to reflect practice patterns for shock wave lithotripsy. Results: One hundred fifty-eight patients were included in the study - 78 underwent SWL and 80 underwent URS as primary treatment. Single procedure stone free rates for SWL and URS were 55% and 95% respectively (p<0.0001). Decision analysis modeling demonstrated cost effectiveness of SWL when SWL single procedure stone free rates (SFR) were 65-67% or when URS single procedure SFR was 72-84%. Conclusions: This retrospective study revealed superior SFR results for renal stones under 1.5cm for URS compared to SWL. Our decision analysis model demonstrates that for SWL stone free rates less than 65-67% or for URS stone free rates greater than 72-84%, SWL is not a cost-effective treatment option. Based on these findings, careful stratification and selection of stone patients may enable surgeons to increase the cost effectiveness of SWL.
    Journal of endourology / Endourological Society 01/2014; 28(6). DOI:10.1089/end.2013.0669 · 1.75 Impact Factor
  • Alejandro Sanchez, Brian H Eisner
    Urology 10/2013; DOI:10.1016/j.urology.2013.05.068 · 2.13 Impact Factor
  • Jonathan Shoag, Brian H Eisner
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    ABSTRACT: To evaluate the relationship between serum c-reactive protein and lifetime kidney stone prevalence. A cross sectional study of particpants from the Continuous National Health and Nutrition Examination Survey (NHANES) from years 2007-2008 and 2008-2009 was performed. Data were available for 11,033 participants. On univariate analysis, a strong correlation exists between CRP quintile and kidney stone history. After adjusting for known confounders, multivariate logistic regression demonstrated a significant relationship between CRP and lifetime prevalence of kidney stones in younger persons (age 20-39, p value for trend = 0.002). For persons aged 20-39, lifetime prevalence of kidney stones increased with increasing CRP quintile (p = 0.002 for trend). Specifically, those in the 3(rd) (OR 3.86, 95% CI 1.07 to 13.88, p = 0.04) and 5(th) quintiles (OR 3.85, 95% CI 1.46 to 10.17, p = 0.009). The fourth quintile of CRP approached statistical significance (OR 2.56, 95% CI 0.96 to 6.81, p = 0.059). The relationship between CRP and kidney stone history was not significant in older age groups (40-59 and 60+). There exists a significant relationship between serum CRP and self-reported kidney stones in younger persons. This may shed light on potential mechanisms of stone formation in this age group and help gain a better understanding of mediators of stone risk. Further studies are necessary to understand the mechanisms which underly these epidemiologic findings.
    The Journal of urology 09/2013; 191(2). DOI:10.1016/j.juro.2013.09.033 · 3.75 Impact Factor
  • Evgeniy I Kreydin, Brian H Eisner
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    ABSTRACT: Since its introduction into the endourologist's armamentarium almost 40 years ago, percutaneous nephrolithotomy (PCNL) has become the standard of care for patients with large-volume nephrolithiasis. Postoperative infection is one of the most common complications of the procedure, and postoperative sepsis is one of the most detrimental. A number of factors have been found to increase the risk of postoperative sepsis. These include patient characteristics that are known preoperatively, such as urine culture obtained from the bladder or from the renal pelvis if percutaneous access to the renal pelvis is obtained in advance to the procedure. Neurogenic bladder dysfunction secondary to spinal cord injury and anatomical renal abnormalities, such as pelvicalyceal dilatation, have also been associated with increased incidence of fever and sepsis after the procedure. Several intraoperative factors, such as the average renal pressure sustained during PCNL and the operative time, also seem to increase the risk of sepsis. Finally, the contribution of postoperative factors, such as presence of a nephrostomy tube or a urethral catheter, has also been investigated. A short preoperative course of antibiotics has been found to significantly decrease the rate of postoperative fever and sepsis. Novel agents targeted at sepsis prevention and treatment, such as anti-endotoxin antibodies and cholesterol-lowering drugs statins, are currently under investigation.
    Nature Reviews Urology 09/2013; DOI:10.1038/nrurol.2013.183 · 4.79 Impact Factor
  • Article: Response.
    Radiology 09/2013; 268(3):926. · 6.21 Impact Factor
  • Radiology 09/2013; 268(3):925-6. DOI:10.1148/radiol.13130697 · 6.21 Impact Factor
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    ABSTRACT: Kidney stone disease is common and may be associated with an increased risk of coronary heart disease (CHD). Previous studies of the association between kidney stones and CHD have often not controlled for important risk factors, and the results have been inconsistent. To examine the association between a history of kidney stones and the risk of CHD in 3 large prospective cohorts. A prospective study of 45,748 men and 196,357 women in the United States without a history of CHD at baseline who were participants in the Health Professionals Follow-up Study (HPFS) (45,748 men aged 40-75 years; follow-up from 1986 to 2010), Nurses' Health Study I (NHS I) (90,235 women aged 30-55 years; follow-up from 1992 to 2010), and Nurses' Health Study II (NHS II) (106,122 women aged 25-42 years; follow-up from 1991 to 2009). The diagnoses of kidney stones and CHD were updated biennially during follow-up. Coronary heart disease was defined as fatal or nonfatal myocardial infarction (MI) or coronary revascularization. The outcome was identified by biennial questionnaires and confirmed through review of medical records. RESULTS Of a total of 242,105 participants, 19,678 reported a history of kidney stones. After up to 24 years of follow-up in men and 18 years in women, 16,838 incident cases of CHD occurred. After adjusting for potential confounders, among women, those with a reported history of kidney stones had an increased risk of CHD than those without a history of kidney stones in NHS I (incidence rate [IR], 754 vs 514 per 100,000 person-years; multivariable hazard ratio [HR], 1.18 [95% CI, 1.08-1.28]) and NHS II (IR, 144 vs 55 per 100,000 person-years; multivariable HR, 1.48 [95% CI, 1.23-1.78]). There was no significant association in men (IR, 1355 vs 1022 per 100,000 person-years; multivariable HR, 1.06 [95% CI, 0.99-1.13]). Similar results were found when analyzing the individual end points (fatal and nonfatal MI and revascularization). Among the 2 cohorts of women, a history of kidney stones was associated with a modest but statistically significantly increased risk of CHD; there was no significant association in a separate cohort of men. Further research is needed to determine whether the association is sex-specific.
    JAMA The Journal of the American Medical Association 07/2013; 310(4):408-15. DOI:10.1001/jama.2013.8780 · 29.98 Impact Factor
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    ABSTRACT: Abstract Objectives: To examine the clinical outcomes and cost-effectiveness of endourologic procedures performed in the office using standard fluoroscopy and topical anesthesia. Methods: We performed a retrospective review of all patients who underwent primary ureteral stent placement, ureteral stent exchange, or ureteral catheterization with retrograde pyeolography or Bacillus Calmette-Guerin (BCG) instillation under fluoroscopic guidance in the office. For an evaluation of potential time savings, we compared this to a cohort of similar procedures performed in the operating room during the same time period. Results: Procedures were attempted in 65 renal units in 38 patients (13 male, 25 female) with a mean age of 62.2 years (range 29.1-95.4 years). Primary ureteral stent placement was successful in 23/24 (95.8%) renal units. Ureteral stent exchange was successful in 19/22 (86.4%) renal units. Ureteral catheterization with retrograde pyelography or BCG instillation was successful in 19/19 (100%) renal units. The total cost savings for the 38 patients in this study, including excess cost from failure in the office, was approximately $91,496, with an average cost savings of $1,551 per procedure. Office-based procedures were associated with a nearly three-fold reduction in total hospital time as a result of reduced periprocedure waiting times. Conclusions: Ureteral stent placement, ureteral stent exchange, and ureteral catheterization can be performed safely and effectively in the office in both men and women. This avoids general anesthesia and provides significant savings of time and cost for both patients and the health care system.
    Journal of endourology / Endourological Society 05/2013; 27(5):662-6. DOI:10.1089/end.2012.0644 · 1.75 Impact Factor
  • Jonathan Shoag, Brian Eisner
    The Journal of Urology 04/2013; 189(4):e851. DOI:10.1016/j.juro.2013.02.2493 · 3.75 Impact Factor

Publication Stats

609 Citations
393.70 Total Impact Points

Institutions

  • 2006–2015
    • Massachusetts General Hospital
      • • Department of Urology
      • • Department of Radiology
      Boston, Massachusetts, United States
  • 2009–2014
    • Harvard Medical School
      • Department of Radiology
      Boston, Massachusetts, United States
  • 2008–2014
    • Harvard University
      Cambridge, Massachusetts, United States
    • University of California, Irvine
      • Department of Urology
      Irvine, California, United States
  • 2013
    • Dartmouth–Hitchcock Medical Center
      • Department of Surgery
      Lebanon, NH, United States
  • 2012
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2011
    • Beverly Hospital, Boston MA
      BVY, Massachusetts, United States
    • University of British Columbia - Vancouver
      • Department of Urologic Sciences
      Vancouver, British Columbia, Canada
  • 2009–2011
    • University of California, San Francisco
      • Department of Urology
      San Francisco, California, United States