Brian H Eisner

Harvard Medical School, Boston, Massachusetts, United States

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Publications (144)531.96 Total impact

  • Natalia Hernandez · Yan Song · Vicki E. Noble · Brian H. Eisner
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    ABSTRACT: Purpose The ability to objectively predict which emergency department patients are likely to have a ureteral stone may aid in cost-effectiveness and patient-centered diagnostic imaging decisions. We performed an external validation of the STONE score, a clinical prediction rule for the presence of uncomplicated ureteral stones in emergency department patients developed at Yale University School of Medicine. Methods Five hundred thirty-six (536) consecutive patients evaluated in an urban tertiary care emergency department for the possible diagnosis of ureteral stone were retrospectively reviewed. The STONE score uses five factors (gender, duration of pain, race, nausea/vomiting, erythrocytes on urine dipstick) to categorize patients into low, medium, and high probability of having a ureteral stone. The total STONE score risk is 0–13 and divided into three groups: low risk = 0–5, moderate risk = 6–9, and high risk = 10–13. Results Of the 536 patients evaluated for suspected ureteral stone, 257 (47.8 %) had a ureteral stone. Mean patient age was 45.9 years (SD 16.3), and gender distribution was 43.9 % female and 56.1 % male. Distribution of STONE score risk was 24.1 % low, 48.1 % moderate, and 27.7 % high. Diagnosis of ureteral stone by STONE score risk was 14 % for low-risk group, 48.3 % for moderate-risk group, and 75.8 % for high-risk group. This distribution is consistent with internal validation at Yale University School of Medicine, where values were 8.3–9.2 % for low risk, 51.3–51.6 % for moderate risk, and 88.6–89.6 % for high risk. Conclusions Our study validates the use of the STONE clinical score to categorize patients as low, moderate, and high risk for ureteral stone. This could help guide development of clinical decision rules for diagnostic studies and imaging in the future.
    No preview · Article · Jan 2016 · World Journal of Urology
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    ABSTRACT: Introduction: While computerized tomography (CT) is the gold standard for diagnosis of ureterolithiasis, ultrasound is a less costly and radiation-free alternative which is commonly used to evaluate patients with ureteral colic. The purpose of this study was to evaluate the frequency with which patients with ureteral stones and renal colic demonstrate hydronephrosis in order to better understand the evaluation of these patients. Methods: Two hundred and forty-eight consecutive patients presenting with ureteral colic and diagnosed with a single unilateral ureteral stone on CT scan in an urban tertiary care emergency department were retrospectively reviewed. Radiology reports were reviewed for stone size, diagnosis, and degree of hydronephrosis. Results: Of the 248 patients evaluated for suspected ureteral stone, 221 (89.1 %) demonstrated any hydronephrosis, while 27 (10.9 %) did not. Hydronephrosis grade, available in 194 patients, was as follows: mild-70.6 %, moderate-27.8 %, and severe-1.5 %. Mean patient age was 47.0 years (SD 15.5), gender distribution was 35.9 % female and 64.1 % male, and mean stone axial diameter was 4.1 mm (SD 2.4). Stone location was as follows: ureteropelvic junction-4.1 %, proximal ureter-21 %, distal ureter-24.9 %, and ureterovesical junction-47.1 %. Axial stone diameter and coronal length (craniocaudal) were both significant predictors of degree of hydronephrosis (ANOVA, p < 0.001 for both). Age (ANOVA, p = NS), stone location (Chi square, p = NS), and gender (Chi square, p = NS) were not associated with degree of hydronephrosis. Conclusions: In patients with ureteral stones and colic, nearly 11 % do not demonstrate any hydronephrosis and a majority (nearly 71 %) will demonstrate only mild hydronephrosis. Stone diameter appears to be related to degree of hydronephrosis, whereas age, gender, and stone location are not. The lower incidence of hydronephrosis for small stones causing renal colic may explain the lower diagnostic accuracy of ultrasound when compared to CT for detecting ureteral stones.
    No preview · Article · Dec 2015 · World Journal of Urology
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    ABSTRACT: Renal papillary calcification is a compelling candidate risk factor for chronic kidney disease (CKD) and nephrolithiasis. Renal papillary density (RPD), as assessed by computed tomography (CT), is a potential marker for calcification that has not been well studied. We developed a protocol to measure RPD using CT scans and assessed its reproducibility in participants from the Framingham Heart Study. We assessed RPD of right kidneys from a single abdominal CT slice in 100 representative participants from the Framingham Heart Study (47 % female, mean age 59.9 years) using a novel protocol. We selected the kidney slice with the most open sinus space and assessed RPD using the average of three 20 mm 2 ellipses from upper, middle and lower papillary regions. Two different readers performed RPD measurements and the first reader repeated all measurements to determine both intra- and inter-reader reproducibility, respectively. Of 100 total individuals included in the replication dataset, six were excluded for poor scan quality. Average RPD across all individuals was 48.7 ± 4.7 (range 38.7–61.7) Hounsfield Units (HU). The intra- and inter-reader correlation coefficients were 0.86 and 0.79, respectively. Bland–Altman analysis suggested no systematic bias between the different reads. Measuring RPD is practical and reproducible using MDCT scans from a small sample of a community-based cohort.
    No preview · Article · Dec 2015 · BMC Research Notes
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    ABSTRACT: Two previous studies (<10 patients each) have demonstrated that alkali therapy may reduce urine calcium excretion in patients with calcium oxalate nephrolithiasis. The hypothesized mechanisms are (1) a decrease in bone turnover due to systemic alkalinization by the medications; (2) binding of calcium by citrate in the gastrointestinal tract; (3) direct effects on TRPV5 activity in the distal tubule. We performed a retrospective review of patients on potassium citrate therapy to evaluate the effects of this medication on urinary calcium excretion. A retrospective review was performed of a metabolic stone database at a tertiary care academic hospital. Patients were identified with a history of calcium oxalate nephrolithiasis and hypocitraturia who were on potassium citrate therapy for a minimum of 3 months. 24-h urine composition was assessed prior to the initiation of potassium citrate therapy and after 3 months of therapy. Patients received 30-60 mEq potassium citrate by mouth daily. Inclusion criterion was a change in urine potassium of 20 mEq/day or greater, which suggests compliance with potassium citrate therapy. Paired t test was used to compare therapeutic effect. Twenty-two patients were evaluated. Mean age was 58.8 years (SD 14.0), mean BMI was 29.6 kg/m(2) (SD 5.9), and gender prevalence was 36.4 % female:63.6 % male. Mean pre-treatment 24-h urine values were as follows: citrate 280.0 mg/day, potassium 58.7 mEq/day, calcium 216.0 mg/day, pH 5.87. Potassium citrate therapy was associated with statistically significant changes in each of these parameters-citrate increased to 548.4 mg/day (p < 0.0001), potassium increased to 94.1 mEq/day (p < 0.0001), calcium decreased to 156.5 mg/day (p = 0.04), pH increased to 6.47 (p = 0.001). Urine sodium excretion was not different pre- and post-therapy (175 mEq/day pre-therapy versus 201 mEq/day post-therapy, p = NS). Urinary calcium excretion decreased by a mean of 60 mg/day on potassium citrate therapy-a nearly 30 % decrease in urine calcium excretion. These data lend support to the hypothesis that alkali therapy reduces urine calcium excretion.
    Full-text · Article · Nov 2015 · Urolithiasis

  • No preview · Article · Aug 2015
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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.
    Full-text · Article · Jul 2015 · Advances in chronic kidney disease
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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.
    Full-text · Article · Jul 2015 · Indian Journal of Urology
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    Full-text · Article · May 2015 · Gastrointestinal Endoscopy
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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.
    Full-text · Article · Apr 2015 · The Journal of urology
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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).
    No preview · Article · Apr 2015 · Journal of endourology / Endourological Society
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    Full-text · Article · Apr 2015 · The Journal of Urology
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    Preview · Article · Apr 2015 · The Journal of Urology
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    ABSTRACT: Background: AUA Best Practice Guidelines for ureteroscopic stone treatment recommend antibiotics coverage for <24 hours following the procedure. The purpose of this study was to evaluate if the addition of postoperative antibiotics reduces urinary tract infections (UTIs) following ureteroscopic stone treatment beyond the recommended preoperative dose. Methods: A retrospective review was performed of consecutive patients at two institutions, University of British Columbia and Massachusetts General Hospital, Harvard. All patients received a single dose of antibiotics prior to ureteroscopic stone treatment. A subset of patients were also given postoperative antibiotics. The rate of UTI was compared in patients receiving only pre-operative antibiotics (Group 1) versus those who received pre and post-operative antibiotics (Group 2). Results: Eighty one patients underwent ureteroscopy for renal calculi. Mean time to follow up was 42 +/- 88 days. Eight (9.9%) patients in total (2 from group 1 and 6 from group 2, p = 0.1457) developed UTIs postoperatively. In group 1, both patients presented with pyelonephritis (2); those patients with infections in group 2 presented with urosepsis (2), cystitis (2), and 2 had asymptomatic bacteriuria. Risk factors such as preoperative stenting, nephrostomy tubes, and foley catheters did not differ between groups nor did they predispose patients to postoperative infections. Conclusions: The postoperative UTI rate in this study (9.9%) is consistent with previous reports. Our data suggests that a single pre-operative dose of antibiotics is sufficient, and additional post-operative antibiotics do not decrease infection rates after ureteroscopic stone treatment. Risk for selection bias is a potential limitation.
    Full-text · Article · Apr 2015 · The Journal of Urology
  • Yan Song · Natalia Hernandez · Andrew Stamm · Brian Eisner

    No preview · Article · Apr 2015 · The Journal of Urology
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    Preview · Article · Apr 2015 · The Journal of Urology

  • No preview · Article · Apr 2015 · The Journal of Urology
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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.
    No preview · Article · Feb 2015 · Urolithiasis
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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.
    No preview · Article · Dec 2014 · The Journal of Urology
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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.
    Full-text · Article · Nov 2014 · The Journal of Urology
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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.
    No preview · Article · Oct 2014 · The Journal of Urology

Publication Stats

1k Citations
531.96 Total Impact Points

Institutions

  • 2003-2016
    • Harvard Medical School
      • Department of Radiology
      Boston, Massachusetts, United States
  • 2008-2015
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2005-2015
    • Massachusetts General Hospital
      • • Department of Urology
      • • Department of Radiology
      Boston, Massachusetts, United States
  • 2009-2013
    • Beverly Hospital, Boston MA
      BVY, Massachusetts, United States
  • 2009-2011
    • University of California, San Francisco
      • Department of Urology
      San Francisco, California, United States
  • 2007
    • Boston Children's Hospital
      • Department of Urology
      Boston, Massachusetts, United States