Brian H Eisner

Massachusetts General Hospital, Boston, Massachusetts, United States

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Publications (136)466.5 Total impact

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    ABSTRACT: Historically nephrolithiasis was considered a disease of dehydration and abnormal urine composition. However, over the past several decades, much has been learned about the epidemiology of this disease and its relation to patient demographic characteristics and common systemic diseases. Here we review the latest epidemiologic studies in the field. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
    Advances in chronic kidney disease 07/2015; 22(4). DOI:10.1053/j.ackd.2015.04.004 · 1.94 Impact Factor
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    ABSTRACT: Urolithiasis is a common disease with increasing prevalence worldwide and a lifetime-estimated recurrence risk of over 50%. Imaging plays a critical role in the initial diagnosis, follow-up and urological management of urinary tract stone disease. Unenhanced helical computed tomography (CT) is highly sensitive (>95%) and specific (>96%) in the diagnosis of urolithiasis and is the imaging investigation of choice for the initial assessment of patients with suspected urolithiasis. The emergence of multi-detector CT (MDCT) and technological innovations in CT such as dual-energy CT (DECT) has widened the scope of MDCT in the stone disease management from initial diagnosis to encompass treatment planning and monitoring of treatment success. DECT has been shown to enhance pre-treatment characterization of stone composition in comparison with conventional MDCT and is being increasingly used. Although CT-related radiation dose exposure remains a valid concern, the use of low-dose MDCT protocols and integration of newer iterative reconstruction algorithms into routine CT practice has resulted in a substantial decrease in ionizing radiation exposure. In this review article, our intent is to discuss the role of MDCT in the diagnosis and post-treatment evaluation of urolithiasis and review the impact of emerging CT technologies such as dual energy in clinical practice.
    Indian Journal of Urology 07/2015; DOI:10.4103/0970-1591.156924
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    Gastrointestinal Endoscopy 05/2015; 81(5):AB402. DOI:10.1016/j.gie.2015.03.715 · 4.90 Impact Factor
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    ABSTRACT: To compare infection rates after PCNL in a group of patients without history of prior infection or struvite calculi who received ≤ 24 hours of post-operative antibiotics (i.e. compliance with AUA guidelines) versus a group that received 5-7 days of post-operative antibiotics. A retrospective review was performed of consecutive percutaneous nephrolithotomy procedures in patients without a history of urinary tract infection. Group 1 received ≤ 24 hours of post-operative antibiotics and Group 2 a mean of 6 days of post-operative antibiotics. Fifty-two patients in group 1 (≤ 24 hours of antibiotics) and 30 patients in group 2 (mean 6 days of antibiotics) met inclusion criteria. Five patients in group 1 (9.6%) developed post-operative fever within 72 hours of PCNL, but none demonstrated bacteruria or bacteremia on cultures. No patients in group 1 were treated for urinary tract infection on POD 3-14. Four patients in group 2 (13.3%) developed fever within 72 hours of PCNL, and a single patient demonstrated bacteruria (< 10,000 CFU mixed gram positive bacteria) on culture while no patients demonstrated bacteremia. No patients in group 2 were treated for urinary tract infection on POD 3-14. There were no differences in stone-free rates or need for additional procedures between the 2 groups. In this pilot series, compliance with AUA guidelines for antibiotic prophylaxis did not result in higher rates of infection than a comparable group of 30 patients who received ∼ 6 days of post-operative antibiotics. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of urology 04/2015; DOI:10.1016/j.juro.2015.04.097 · 3.75 Impact Factor
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    ABSTRACT: To examine the association between statin medication use and sepsis risk after percutaneous nephrolithotomy (PCNL) surgery. Using medical claims data, we identified working-age adults with urinary stone disease treated with PCNL. Among this cohort, we determined which patients had a prescription fill for a statin agent that encompassed their surgery date. We then fitted logistic regression models to examine for differences in rates of postoperative sepsis between statin users and non-users. In addition, we evaluated the frequency of non-febrile urinary tract infections (UTIs) and intensive care services (ICU) utilization and hospital length of stay (LOS) as a function of statin use. During the study period, at total of 2,046 patients underwent PCNL, 382 (18.7%) of whom had a prescription fill for a statin agent preceding their surgery. The overall rate of sepsis in this population was 3.8%. After adjusting for patient health status and sociodemographic factors, the rate of postoperative sepsis was comparable between statin users and non-users (5.3% vs. 3.5%, respectively; P=0.105). In addition, UTI and ICU utilization rates did not relate to statin use (P>0.05 for all associations). Adjusted hospital LOS was shorter among statin users, but the difference was clinically trivial (3.6 versus 4.1 days; P=0.007). Statin use is not associated with reductions in the postoperative sepsis, non-febrile UTIs, ICU utilization, or hospital LOS following PCNL. To increase the safety of PCNL, urologists will have to consider other processes of care (e.g., clinical care pathways).
    Journal of endourology / Endourological Society 04/2015; DOI:10.1089/end.2015.0042 · 2.10 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e353-e354. DOI:10.1016/j.juro.2015.02.600 · 3.75 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e453-e454. DOI:10.1016/j.juro.2015.02.1394 · 3.75 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e951-e952. DOI:10.1016/j.juro.2015.02.2709 · 3.75 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e228. DOI:10.1016/j.juro.2015.02.986 · 3.75 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e1019. DOI:10.1016/j.juro.2015.02.2837 · 3.75 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e507. DOI:10.1016/j.juro.2015.02.1646 · 3.75 Impact Factor
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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; 193(5). DOI:10.1016/j.juro.2014.10.089 · 3.75 Impact Factor
  • Seth K. Bechis, Brian H. Eisner
    Urology 09/2014; 84(3):542-543. DOI:10.1016/j.urology.2014.03.063 · 2.13 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 · 2.10 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e76. DOI:10.1016/j.juro.2014.02.349 · 3.75 Impact Factor

Publication Stats

738 Citations
466.50 Total Impact Points

Institutions

  • 2005–2015
    • Massachusetts General Hospital
      • • Department of Urology
      • • Department of Radiology
      Boston, Massachusetts, United States
  • 2003–2015
    • Harvard Medical School
      • Department of Radiology
      Boston, Massachusetts, United States
  • 2007–2014
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2013
    • Dartmouth–Hitchcock Medical Center
      • Department of Surgery
      Lebanon, NH, United States
  • 2012
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2011
    • University of British Columbia - Vancouver
      • Department of Urologic Sciences
      Vancouver, British Columbia, Canada
  • 2009–2011
    • Beverly Hospital, Boston MA
      BVY, Massachusetts, United States
    • University of California, San Francisco
      • Department of Urology
      San Francisco, California, United States