How To Live Longer: Regular Low Doses Of Ibuprofen Found To Extend The Lives Of Animals By 15 Percent

What’s orange, may be able to extend your life, and is probably already in the back of your medicine cabinet? Ibuprofen. A recent study found that regular small doses of the pill extended the lives of animal subjects by up to 15 percent. Not only did the animals live longer, but they also lived healthier, and scientists believe the same effect could be seen in humans.


In the study, scientists gave a number of species doses of ibuprofen that would be comparable to the recommended human dose. They first began their tests on baker’s yeast, but then moved on to worms and flies. Results showed that over time this extended the test subjects’ lives by 15 percent, which when translated into human life is about an extra dozen years of life.

“We are not sure why this works, but it’s worth exploring further,” explained Dr. Michael Polymenis, one of the collaborating researchers who had taken part on the study, in a press release.

Ibuprofen interferes with the ability of yeast cells to pick a universal amino acid called tryptophan. This molecule is essential for human life, and ibuprofen’s effect on it results in longer healthier lives.

While the findings are exciting, Polymenis explained to Medical Daily in an email that he did not recommend anyone take ibuprofen regularly without first consulting a physician.

“We just need more research to examine and understand these properties,” Polymenis said.

This study was the first to show that relatively safe drugs are capable of extending lifespans, and according to Polymenis, ibuprofen may not be the only drug with this unique capability.

“This study was a proof of principle to show that common, relatively safe drugs in humans can extend the lifespan of very diverse organisms. Therefore, it should be possible to find others like ibuprofen with even better ability to extend lifespan, with the aim of adding healthy years of life in people,” Polymenis said.

Ibuprofen is a nonsteroidal anti-inflammatory drug. It was first created in England in the 1960s and is listed on the World Health Organization’s “list of essential medication.” The drug is used to reduce fever and treat pain or inflammation. It’s commonly used as a quick and easy treatment for minor ailments such as headaches, toothaches, back pain, arthritis, and menstrual cramps.

“Our institute is interested in finding out why people get sick when they get old. We think that by understanding those processes, we can intervene and find ways to extend human health span, keeping people healthier longer and slowing down aging. That’s our ultimate goal,” concluded Dr. Brian Kennedy, CEO of the Buck Institute, in the press release.


Researchers solve the mystery of how humans evolved colour vision

Scientists have figured out how, over several million years, our ancestors evolved from primitive mammals that could only see dim, shadowy light to great apes with clear colour vision.

After two decades of work, an international team of researchers has discovered how humans evolved to see all the colours of the rainbow. By figuring out how our ancestors swapped ultraviolet (UV) vision for blue-light (or violet) vision, they have finally pieced together a timeline for one of our species’ most defining features.

“We have now traced all of the evolutionary pathways, going back 90 million years, that led to human colour vision,” lead author and biologist, Shozo Yokoyama from Emory University in the US, said in a press release. “We’ve clarified these molecular pathways at the chemical level, the genetic level and the functional level.”

In previous studies, Yokoyama and his colleagues showed that our early ancestors added green-sensitivity to their pre-existing red-sensitivity between 45 and 30 million years ago. To pinpoint how we ended up with the tricolour vision that allows us to see all the colours of the visible spectrum today, he needed to figure out when the eyes of our ancestors achieved blue-light vision.

In 2008, Yokoyama and his team showed how the deep sea scabbardfish switched from UV vision to blue-light vision thanks to a single genetic mutation. Our ancestors, of the other hand, needed to undergo many genetic mutations over several million years to achieve the same. “The evolution for our ancestors’ vision was very slow, compared to this fish, probably because their environment changed much more slowly,” says Yokoyama.

This time, the team looked deeper into this process by analysing ancestral molecules – proteins and pigments once present in our earlier ancestors that can now be synthesised in the lab. They discovered that five classes of opsin genes, which are found in the photoreceptor cells of the mammalian retina, are needed to encode visual pigments for dim-light and colour vision. As the environment changes around a species over tens of millions of years, they found, little bits of these opsin genes change with it to allow their vision to adapt.

Publishing in the journal PLOS Genetics, Yokoyama’s team found that about 90 million years ago, our early mammalian ancestors were nocturnal creatures with UV-sensitive and red-sensitive vision. This means they basically saw the world in just two colours. Then, by around 30 million years ago, these mammals had evolved into primates with four different classes of opsin genes, which allowed them to see entire spectrum of visible light – everything except UV light.

“Gorillas and chimpanzees have human colour vision,” said Yokoyama in the press release. “Or perhaps we should say that humans have gorilla and chimpanzee vision.”

They found that seven genetic mutations and 5,040 possible pathways for the amino acid changes were required to bring about the evolution of human tri-colour vision. “We did experiments for every one of these 5,040 possibilities,” Yokoyama says. “We found that of the seven genetic changes required, each of them individually has no effect. It is only when several of the changes combine in a particular order that the evolutionary pathway can be completed.”

According to the press release, this means environmental influences were not enough to drive the evolution of colour vision – the change also required shifts in our ancestors’ molecular environment.

The team found that about 80 percent of the 5,040 pathways stopped in the middle because a protein had finally been rendered useless by a new mutation that preceded it in the pathway. “The remaining 20 percent of the pathways remained possible pathways, but our ancestors used only one,” Yokoyama says. “We identified that path.”

It’s pretty incredible to consider how such a drawn-out and complex series of changes could come together to result in something that most of us now take for granted.

“We have no more ambiguities,” Yokoyama says. “Down to the level of the expression of amino acids, for the mechanisms involved in this evolutionary pathway.”


NASA Discovers Hidden Portals In Earth’s Magnetic Field.

Our planet has come a long way in scientific breakthroughs and discoveries. Mainstream science is beginning to discover new concepts of reality that have the potential to change our perception about our planet and the extraterrestrial environment that surrounds it forever. Star gates, wormholes, and portals have been the subject of conspiracy theories and theoretical physics for decades, but that is all coming to an end as we continue to grow in our understanding about the true nature of our reality.


In physics, a wormhole was a hypothetical feature of space time that would be a shortcut through space-time. We often wonder how extraterrestrials could travel so far and this could be one of many explanations. Although scientists still don’t really understand what they have found, it does open the mind to many possibilities.

NASA Discovers Hidden Portals In Earth’s Magnetic FieldTurning science fiction into science fact seems to happen quite often these days and NASA did it by announcing the discovery of hidden portals in Earth’s magnetic field.

NASA calls them X-points or electron diffusion regions. They are places where the magnetic field of Earth connects to the magnetic field of the Sun, which in turn creates an uninterrupted path leading from our own planet to the sun’s atmosphere which is 93 million miles away.

NASA used its THEMIS spacecraft, as well as a European Cluster probe, to examine this phenomenon. They found that these portals open and close dozens of times each day. It’s funny, because there is a lot of evidence that points toward the sun being a giant star gate for the ‘gods’ to pass back and forth from other dimensions and universes. The portals that NASA has discovered are usually located tens of thousands of kilometres from Earth and most of them are short-lived; others are giant, vast and sustained.

As far as scientists can determine, these portals aid in the transfer of tons of magnetically charged particles that flow from the Sun causing the northern and southerns lights and geomagnetic storms. They aid in the transfer of the magnetic field from the Sun to the Earth. In 2014, the U.S. space agency will launch a new mission called Magnetospheric Multi scale Mission (MMS) which will include four spacecraft that will circle the Earth to locate and then study these portals. They are located where the Earth and the Sun’s magnetic fields connect and where the unexplained portals are formed.

NASA funded the University of Iowa for this study, and they are still unclear as to what these portals are. All they have done is observed charged particles flowing through them that cause electro-magnetic phenomenon in Earth’s atmosphere.

Magnetic portals are invisible, unstable and elusive. they open and close without warming and there are no signposts to guide is in – Dr Scudder, University of Iowa

Mainstream science continues to grow further, but I often get confused between mainstream science, and science that is formed in the black budget world. It seems that information and discovery isn’t information and discovery without the type of ‘proof’ that the human race requires. Given that the human race requires, and has a certain criteria for ‘proof’, which has been taught to us by the academic world, information can easily be suppressed by concealing that ‘proof’.

It’s no secret that the department of defence receives trillions of dollars that go unaccounted for and everything developed within the United States Air Force Space Agency remains classified. They are able to classify information for the sake of ‘national security’. Within the past few years, proof has been emerging for a number of phenomenon that would suggest a whole other scientific world that operates separately from mainstream science.

We have the technology to take ET home, anything you can imagine we already have the technology to do, but these technologies are locked up in black budget projects. It would take an act of God to ever get them out to benefit humanity – Ben Rich, Fmr CEO of LockHeed Skunk Works

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Clot-Grabbing Devices Offer Better Outcomes for Stroke Patients than Drugs

Going into the blocked artery of someone who is having a stroke to remove the clot is more likely to produce a good recovery than treatment with just clot-busting drugs, according to a study

 Going into the blocked artery of someone who is having a stroke to remove the clot is more likely to produce a good recovery than treatment with just clot-busting drugs, according to a study of 500 patients in the Netherlands.

“Catching the clot and fishing it out of the blocked artery to reopen it makes a big difference in outcome,” Dr. Jeffrey Saver, a director of the University of California Los Angeles Stroke Center, told Reuters Health. The devices to retrieve clots have been around for a while but until now “we hadn’t had a clinical trial showing that they made patients better.”

Ninety days after their strokes, 32.6 percent of patients whose treatment included going into a brain artery to remove a clot achieved functional independence, compared to 19.1 percent given only usual care with clot-dissolving drugs.

The study, known as MR CLEAN and published online Wednesday by the New England Journal of Medicine, applies to patients whose strokes were the result of a blockage in the large forward arteries of the brain. But that’s the most common type of stroke, and the findings could affect up to 125,000 patients in the U.S. and 90,000 in Europe each year.

“We’re talking about the sickest stroke patients, the ones with blockages of their main arteries leading to the brain, and these patients account for the majority of disability and death related to stroke,” study coauthor Dr. Albert J. Yoo, director of Acute Stroke Intervention at Massachusetts General Hospital in Boston, told Reuters Health by phone.

Dr. Saver, who was not involved in the study, said the findings should give people an even stronger reason to get someone to the hospital as quickly as possible if they demonstrate stroke symptoms, such as facial drooping, arm weakness or speech difficulties.

“Stroke is now an even more treatable disease today than it was yesterday,” he said, citing the availability in some centers of the clot-extracting devices that can be used in combination with clot-dissolving drugs. “But we can only use them if patients get to the hospital in time.”

All the patients in the new study who were treated with the devices received their surgery within six hours of the onset of symptoms. Nine out of ten were initially treated with injections of tPA, a clot-dissolving drug, before the researchers determined who would be in the group that also received the clot-extraction procedure.

Typically, the clot-busting drug only opens the blocked artery in about a third of cases.

“Until now, people were lucky to get intravenous tPA. But the majority of those patients still have poor outcomes,” said Dr. Yoo. “The field was looking for a better option and MR CLEAN showed that we do have a better option.”

“There was no difference in the death rate, but every other category demonstrated improvement,” he said.

The only significant difference in side effects was that 5.6 percent of the patients whose clots were extracted had signs of a subsequent stroke within 90 days. The rate was 0.4 percent in the group that received standard care.

Past comparisons of tPA and clot-removing devices had given less-promising results, said Dr. Sidney Starkman, the other co-director of the UCLA stroke center, who was involved in two of those earlier studies. That quelled interest in clot-removing devices.

But the technology has improved dramatically, the new study reflects those improvements and the latest data should renew interest in those devices, he said in an interview.

“There has been hesitancy to use these” devices, Saver said, because “the earlier generation of these devices were not nearly as effective in opening the blocked arteries and they had not shown a benefit above medical therapy.”

With the new results, “I think there’s going to be a push to get more centers offering this treatment,” Yoo said. “We needed the evidence, and now that we have the evidence, this is going to provide the impetus to have more centers capable of doing this.”

SOURCE: New England Journal of Medicine, online December 17, 2014.

Do Depressed Moms Predispose Kids to Behavorial Problems?

Study links maternal depression to teens’ risky behavior.

Adolescents are more likely to engage in substance use and risky behavior if they were exposed to symptoms of maternal depression during their middle childhood years, according to a study published online in Pediatrics.

Middle childhood is a period of increasing cognitive, social, and emotional development, which may be particularly relevant to the development of both internalizing and externalizing behavioral patterns, the authors wrote.

The study found adolescents who had been exposed to “high symptoms” of maternal depression from ages 4 to 8, and “decreasing symptoms” as they got older were more likely to engage in “nonviolent delinquent behaviors” (P=0.03) as teenagers than adolescents exposed to a” lower level of maternal depressive symptoms.” Such behaviors included “stealing, destruction of property, running away, and being out all night.”

These adolescents were also more likely to use “common substances” such as cigarettes, alcohol, marijuana, and hallucinogenic drugs (P=0.005) and at an earlier age (P<0.001) than their study counterparts who had a low level of exposure to maternal depression during middle childhood.

This suggests a relationship between a child’s development and a mother’s state of mind, even before a child is old enough to make decisions about certain high-risk behaviors and activities. “Maternal mental health is important throughout a child’s life and not providing appropriate support and treatment for possible maternal mental illness may have consequences for their children,” said study author Ian Colman, PhD, faculty of medicine, department of epidemiology and community medicine at the University of Ottowa.

Mark A. Reinecke, PhD, professor, psychiatry and behavioral sciences at Northwestern University in Evanston, Ill., points out that until now, the majority of research and clinical attention about maternal depression has been focused on postpartum depression when children are infants or toddlers. “I think what this study does is it encourages us to take a long view – to think about maternal depression not just during early childhood and the perinatal period, but also the delayed effects of maternal depression,” Reinecke said.

Researchers examined data from a Canadian cohort study, the National Longitudinal Survey of Children and Youth (NLSCY). The study analyzed a representative sample of 2,910 mother-youth pairs. Children were surveyed every two years, from 1994 to 1995 at the ages of 2 to 5, and ending in 2008 and 2009 until they reached age 16 or 17. Mothers of the children completed the questionnaires for them until they turned 10 or 11, when the children then answered the questions themselves.

Mothers were given a shortened form of the Center for Epidemiologic Studies Depression Scale (CES-D), which included a series of questions about their feelings (such as “I felt depressed” and “I felt hopeful about the future”). Respondents answered using 4 response categories ranging from “rarely to none of the time (<1 day)” to “most or all of the time (5-7 days).” Scores were calculated on a scale of 0 to 36, with mean scores of 3.98 to 4.81. The cutoff score for presence of depression was 12.

Although 10% to 17% of mothers at least exhibited the presence of depression, only 1.7% could have been diagnosed with clinical depression. But Reinecke suggests this distinction is important because it means having a mother who is merely feeling “sad or depressed or down” can still have an impact on a child’s development. Screening for these kinds of feelings in women may be a practical, simple thing for a clinician to do, Reinecke said.

One limitation of the study is its time frame – a questionnaire taken once every two years only gives an idea of the mother’s state of mind around the period of the survey as opposed to over a longer time period. Both Colman and Reinecke also pointed out that while the study suggests middle childhood exposure to maternal depression may predict risky behavior in adolescents, there are likely other contributing factors.

“We would be really interested in finding out about the fathers and what their mental health might be like,” said Colman. “I think there’s a real gap in the literature about paternal depression and effects that may have on the child.”

Reinecke observed that while the study may have statistical significance, it is unclear whether it has clinical significance. Several other variables, such as shared biology, a child’s environment, learned experiences, and parental modeling also likely play a role in predicting substance abuse and risky behavior in teenagers, and would be additional theories a clinician should take into consideration.

“What are the biological, social, cognitive, and environmental factors of having a sad mother during one week or two weeks during your childhood that lead to these negative outcomes years later?” Reinecke said. “That’s a conceptually important question.”

Synovitis Is Precursor of Radiographic Knee OA

Study finds inflammation plays early role in the disease.

The presence of effusion-synovitis or Hoffa-synovitis significantly increases the risk of radiographic knee osteoarthritis (OA) according to a nested, case control study conducted by an international team of investigators.

Whereas synovitis in OA was previously believed to be a consequence of underlying joint damage, its discovery suggests “that synovial membrane inflammation plays a role early in the disease. These findings are further supported by previous research on knees without OA, which shows that synovitis and effusion increase risk for cartilage loss,” they wrote online in Annals of Rheumatic Diseases. “Therefore, our findings concur withprevious findings which indicate at least an accelerating role of inflammation in disease initiation.”

Led by I. Atukorala at the University of Sydney in Australia, the investigators selected 133 knees (from 120 persons) that developed radiographic knee OA within 48 months of having a Kellegren Lawrence grading (KLG) of 0 on knee radiographs. All case subjects were enrolled in the OA Initiative, a multicenter, 8-year, prospective, observational cohort of subjects with knee OA or at high risk of developing knee OA. Radiographic knee OA in these cases was defined as KLG ≥2 on postero-anterior view during the study period. Cases were matched with 133 control knees that also had a KLG of 0 at baseline but did not develop radiographic OA.

At baseline, 69.92% of cases and 78.95% of controls were pain free or had infrequent knee pain; 40% of cases had frequent knee pain compared with 28% of controls.

At the onset of radiographic OA, 57.1% of cases had frequent knee pain and 25.6% had infrequent pain. A history of injury was reported by 20.3% of cases and 12.8% of controls at baseline, and a history of knee surgery by 3.76% and 3.01%, respectively. The KLG of cases at the time of radiographic OA was 2 in 75.9%, 3 in 22.6%, and 4 in 1.5%, whereas 97.7% of controls remained at a KLG of 0 and only 2.3% reached KLG 1.

Effusion-synovitis in the year prior to occurrence of radiographic knee OA tripled the odds of subsequent incident radiographic knee OA (52.80% in cases versus 29.60% in controls, OR 3.23, 95% CI 1.72-6.06). This relationship persisted (OR 4.70, 95% CI 2.35-9.34) at the time of onset of radiographic OA.

Associations between Hoffa-synovitis and incident radiographic knee OA in cases (versus controls) achieved significance at baseline (46.21% in cases versus 30.83%, OR 1.80, CI 1.10-2.96), the year prior to a finding of radiographic OA (53.23% versus 30.40%, respectively, OR 2.47, CI 1.45-4.23), and concurrent with incident radiographic OA (OR 2.40, CI 1.43-4.04).

Adjusting for potential covariates in sensitivity analyses did not change the association between synovitis/effusion-synovitis and the occurrence of radiographic OA.

Because synovial inflammation was more marked in the year preceding development of radiographic knee OA, it suggests that synovitis predates, and is also associated with the development of radiographic OA, according to the authors.

They add that “treating synovitis in knee OA may have a role in reducing progression of the disease and providing symptom relief. Therefore, the results of this study are useful in identifying a targeted therapy to alter the pathogenesis of knee OA.”

Limitations of the study are the use of non-contrast-enhanced magnetic resonance imaging, for practical reasons, to identify synovitis, and the retrospective study design.

NASA Tests Software That May Help Increase Flight Efficiency, Decrease Aircraft Noise

NASA flight engineer Roy Roper (left) reviews laptop displays showing the ASTAR data with Boeing principal investigator
NASA flight engineer Roy Roper (left) reviews laptop displays showing the ASTAR data with Boeing principal investigator Gabe Brewer during a ground simulation.

NASA researchers Friday began flight tests of computer software that shows promise in improving flight efficiency and reducing environmental impacts of aircraft, especially on communities around airports.

Known as ASTAR, or Airborne Spacing for Terminal Arrival Routes, the software is designed to give pilots specific speed information and guidance so that planes can be more precisely spaced, enabling pilots to fly a “follow the leader” approach to their destination airport.

This type of approach would minimize flight path deviations, allow more efficient use of existing airspace and possibly reduce noise over communities surrounding airports – all of which could lead to reductions in commercial flight delays.

The software is being  tested on the Boeing ecoDemonstrator 787 Test Airplane as part of  The Boeing Company’s ecoDemonstrator Program, a multi-year effort that aims to identify and accelerate the development and testing of new technologies and methods that can potentially reduce the environmental impacts of aviation.

“ASTAR represents the first of several inventive technologies NASA’s aeronautical innovators are working on that will be tested with the help of the ecoDemonstrator test airplanes,” said Jaiwon Shin, associate administrator for NASA’s Aeronautics Research Mission Directorate at the agency’s headquarters in Washington. “We’re confident the public will benefit from this valuable partnership between NASA and Boeing.”

During the flight tests, NASA engineer Roy Roper operates ASTAR on a laptop in the rear of the aircraft. As a second aircraft flies in front of the ecoDemonstrator 787, ASTAR computes and displays the speed required to follow safely behind. Roper then communicates those speed commands to the ecoDemonstrator 787 pilots.

“NASA has tested ASTAR in laboratory simulations, but this flight test on board the ecoDemonstrator 787 gave us the chance to see how well it works in a real-life flight environment,” said Will Johnson, a project chief engineer at NASA’s Langley Research Center in Hampton, Virginia.

The NASA team will apply the lessons learned from the flight test program to improve the software and then begin development of actual flight hardware for further testing and eventual certification for use.

The ASTAR experiment is the first of several NASA tests flying aboard the ecoDemonstrator Test Airplanes. During the spring and summer of 2015, the ecoDemonstrator 757 Test Airplane will host two NASA experiments. The first involves using active flow control technologies on the aircraft’s tail to determine if future tail designs can be altered to reduce drag. The second will test the effectiveness of coatings applied to the leading edge of a wing section to reduce turbulence-inducing buildup of insect residue.

Air traffic management software tools, such as ASTAR, are developed by NASA’s Airspace Systems Program, which is part of the agency’s Aeronautics Research Mission Directorate.

Efficacy and safety of photodynamic therapy for recurrent, high grade nonmuscle invasive bladder cancer refractory or intolerant to bacille Calmette-Guérin immunotherapy.



We evaluated the effectiveness of photodynamic therapy using Radachlorin in patients with high grade, nonmuscle invasive bladder cancer refractory or intolerant to bacillus Calmette-Guérin therapy who refused radical cystectomy.

Materials and methods

Between July 2009 and December 2011 photodynamic therapy was performed in 22 men and 12 women. Radachlorin (0.5 to 0.6 mg/kg) was injected intravenously 2 to 3 hours before photodynamic therapy. After complete transurethral resection, a diffuser using a 22 Fr cystoscope was placed in the bladder for irradiation with a 662 nm laser. Output beam power was adjusted to 1.8 W and the light dose was 15 J/cm(2). Photodynamic therapy was performed for 16 to 30 minutes. Recurrence after photodynamic therapy was followed by regular cystoscopy at 1, 2 and 3 months, and at 3-month intervals thereafter for up to 2.8 years. Efficacy was assessed by cystoscopy, cytology and histology, and defined as the number of patients who were tumor free after initial photodynamic therapy.


Mean±SD patient age was 62.94±8.71 years. Average followup was 26.74±6.34 months (median 28.12). As the primary efficacy outcome, the recurrence-free rate was 90.9% at 12 months, 64.4% at 24 months and 60.1% at 30 months. As the secondary efficacy outcome, there was no statistical difference in mass size, carcinoma in situ, number of previous bacillus Calmette-Guérin administrations, number of transurethral bladder resections or tumor multiplicity on Kaplan-Meier analysis (each p>0.05). No evidence of severe adverse effects was detected after photodynamic therapy.


Photodynamic therapy with Radachlorin is a safe, effective treatment for nonmuscle invasive bladder cancer refractory or intolerant to bacillus Calmette-Guérin therapy in select patients.

2014 Top Stories in Urology: Medical Management of Stone Disease

In 2014, the American Urological Association (AUA) released a clinical guidelines document focused on the medical management of kidney stone disease.1 This important, but often overlooked, aspect of stone management is an “orphan” field. It requires administration and titration of medications, which is not something that urologists commonly do, but it also entails an understanding of surgical stone management, which is not something that nephrologists commonly do.

The document provides detailed guidelines for the metabolic evaluation and medical management of stone patients, with associated levels of evidence (eg, treatment “standards” based on higher level of evidence vs “expert opinion”) to enable the reader to understand the basis for the recommendations. The detailed literature review combined with professional opinion provides recommendations for initial evaluation, dietary therapies, pharmacologic therapies, and follow-up of newly diagnosed patients and those with recurrent disease.

These guidelines are most welcome, as they demystify and organize the approach to the management of patients with this complex problem. While treating a stone surgically is in the purview of most urologists, employing dietary and pharmacological means to reduce recurrence is a less comfortable task for many. The latter is particularly important given the high recidivism of stone formers, the quality-of-life concerns associated with recurrent symptomatic disease, and the significant financial costs associated with this disease.

The lack of level 1 evidence in the guidelines is apparent and calls for more rigorous, prospective study of the prevention and management of stone disease. The take-away point is that there is good evidence for prevention that is already available and underutilized, and these guidelines should provide a digestible means for practitioners to work on prevention rather than simply treatment.

2014 Top Stories in Urology: AUA Urotrauma Guidelines

Practicing urologists have always played an integral role in the evaluation and treatment of acute genitourinary organ injury. Well-established criteria for imaging of blunt trauma, originally pioneered by McAninch and colleagues, have been incorporated in most trauma center protocols. Although trauma surgeons may manage life-threatening renal hemorrhage with nephrectomy, urologist input remains critical when deciding appropriate intervention for all other urinary tract and genital injuries.

The field of genitourinary trauma and reconstruction received a major push toward dissemination of evidence-based best practices with the introduction of the AUA Guideline on Urotrauma.1 Guidelines drive education, policy, and changes in practice patterns that may be adopted worldwide. In addition, gaps in knowledge identified by the evidence review define opportunities for future research.

Urologists can expect two diverging outcomes of the introduction of guidelines. Trauma systems will look to the guidelines to ensure adherence with evidence-based recommendations. This will likely create greater demand for urological consultation and involvement during and after hospitalization. Conversely, if urologists are not willing to provide prompt engagement and collaboration with trauma teams, it is possible that other practitioners will take over decision-making and care of patients with genitourinary injuries.

Key takeaways from the AUA Urotrauma Guidelines include the following:

  1. The surgical team must perform immediate surgery (or angioembolization in selected situations) in hemodynamically unstable patients with no or transient response to resuscitation.
  2. Follow-up imaging is necessary for high-grade renal injuries, although the particular lesions and how to follow them remains unknown.
  3. Ureteral injury should be explored and repaired immediately; if diagnosis is delayed, use a drain-and-wait approach.
  4. Intraperitoneal bladder rupture should always be repaired after blunt trauma.
  5. Extraperitoneal bladder rupture can be classified into complicated and uncomplicated. Complicated injuries require exploration and repair, whereas uncomplicated injuries can be managed with catheter drainage.
  6. Suprapubic tubes may be used in the face of orthopedic hardware as determined by expert opinion; it must be acknowledged that there is little evidence to support the guideline recommendation.
  7. Primary urethral realignment is an option for pelvic fracture urethral injury. Suprapubic cystostomy is almost always the best initial choice for urinary drainage in the acute setting of a pelvic fracture urethral injury. Primary realignment will reduce stricture rates, but prolonged efforts at realignment should be avoided.
  8. Genital injuries require early exploration using correct approaches at the local hospital level based on the mechanism and severity of injury. An exception to this is penile replantation, which should be referred to centers of excellence for microvascular repair.