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Re: Strategy to Control Catheter Encrustation With Citrated Drinks: A Randomized Crossover Study
LETTERS TO THE EDITOR/ERRATA
1987
Re: Strategy to Control Catheter Encrustation With Citrated Drinks: A Randomized Crossover Study A. Khan, F. Housami, R. Melotti, A. Timoney and D. Stickler J Urol 2010; 183: 1390 –1394.
To the Editor: This study confirms previous findings on the potential of lemonade therapy.1 Unfortunately both groups report that citrate raises urine pH. There is another option to consider. Hedelin et al clearly demonstrated that there is no catheter encrustation whatsoever below pH 6.8.2 A vegetarian diet, including citrated beverages, renders the urine basic, while meat, fish and fermented food render it acidic. Yogurt, a staple food in much of the Middle East, is a potent urine acidifier. Five years ago I was treated for low grade papillary transitional cell carcinoma. Then, 30 months ago due to prostatitis I received a 16Fr latex indwelling Foley catheter. Based on a lifetime conviction that spinach and orange juice are good, I indulged in them. During my first 6 months with a Foley I was hospitalized 3 times, made frequent visits to urgent care, and needed several rounds of ciprofloxacin and levofloxacin. Subsequently I radically changed my diet, including some fish or meat daily and a half cup of fat free yogurt 3 times daily. My urine pH changed from above 7.6 to the 6 to 6.5 range. For comfort I also change nightly from the leg bag to a 2 liter overnight bag. For the 2 years during which I have been on this diet I have not had a single catheter encrustation or needed an antibiotic. In fact, I have had no clinical symptoms, although the laboratory reported greater than 100,000 cfu/ml each of Pseudomonas aeruginosa and another unidentified gram-negative bacillus. The consistent acidity of my urine did not revive my papilloma and seems to have abated the virulence of the bacilli. Respectfully, Milan Bier Professor Emeritus Department of Chemical and Environmental Engineering University of Arizona Tucson, Arizona e-mail: [email protected] 1. Penniston KL, Steele TH and Nakada SY: Lemonade therapy increases urinary citrate and urine volumes in patients with recurrent calcium oxalate stone formation. Urology 2007; 70: 856. 2. Hedelin H, Bratt CG, Eckerdal G et al: Relationship between urease-producing bacteria, urinary pH and encrustation on indwelling urinary catheters. Br J Urol 1991; 67: 527.
Re: Imaging Use Among Employed and Self-Employed Urologists J. M. Hollingsworth, J. D. Birkmeyer, Y. S. Zhang, L. Zhang and B. K. Hollenbeck J Urol 2010; 184: 2480 –2484.
To the Editor: I am writing this Letter on behalf of the members of the American Association of Clinical Urologists (AACU). As physicians, we take pride in our calling. It is an honor and a privilege to improve the lives of our patients and treat them to the best of our ability and in the manner that our training and ethics require. This being said, we are disappointed with the authors’ suggestion that salaried physicians derive no financial benefit from providing more care. This article attempts to directly link increased imaging use to urologists who are self-employed. The AACU believes this article attacks the character and motivations of practicing urologists. Many salaried, employed, academic physicians are supported by their department or employer’s clinical income. This clinical income to pay salaries is driven in large part by the services that those hospitals or academic centers provide. Additionally, many salaried employees also receive bonus income based on the margins of their employer. Their estimate based on the National Ambulatory Medical Care Survey (NAMCS) was 28% with a tie to volume but with a standard error of
1987
Re: Strategy to Control Catheter Encrustation With Citrated Drinks: A Randomized Crossover Study A. Khan, F. Housami, R. Melotti, A. Timoney and D. Stickler J Urol 2010; 183: 1390 –1394.
To the Editor: This study confirms previous findings on the potential of lemonade therapy.1 Unfortunately both groups report that citrate raises urine pH. There is another option to consider. Hedelin et al clearly demonstrated that there is no catheter encrustation whatsoever below pH 6.8.2 A vegetarian diet, including citrated beverages, renders the urine basic, while meat, fish and fermented food render it acidic. Yogurt, a staple food in much of the Middle East, is a potent urine acidifier. Five years ago I was treated for low grade papillary transitional cell carcinoma. Then, 30 months ago due to prostatitis I received a 16Fr latex indwelling Foley catheter. Based on a lifetime conviction that spinach and orange juice are good, I indulged in them. During my first 6 months with a Foley I was hospitalized 3 times, made frequent visits to urgent care, and needed several rounds of ciprofloxacin and levofloxacin. Subsequently I radically changed my diet, including some fish or meat daily and a half cup of fat free yogurt 3 times daily. My urine pH changed from above 7.6 to the 6 to 6.5 range. For comfort I also change nightly from the leg bag to a 2 liter overnight bag. For the 2 years during which I have been on this diet I have not had a single catheter encrustation or needed an antibiotic. In fact, I have had no clinical symptoms, although the laboratory reported greater than 100,000 cfu/ml each of Pseudomonas aeruginosa and another unidentified gram-negative bacillus. The consistent acidity of my urine did not revive my papilloma and seems to have abated the virulence of the bacilli. Respectfully, Milan Bier Professor Emeritus Department of Chemical and Environmental Engineering University of Arizona Tucson, Arizona e-mail: [email protected] 1. Penniston KL, Steele TH and Nakada SY: Lemonade therapy increases urinary citrate and urine volumes in patients with recurrent calcium oxalate stone formation. Urology 2007; 70: 856. 2. Hedelin H, Bratt CG, Eckerdal G et al: Relationship between urease-producing bacteria, urinary pH and encrustation on indwelling urinary catheters. Br J Urol 1991; 67: 527.
Re: Imaging Use Among Employed and Self-Employed Urologists J. M. Hollingsworth, J. D. Birkmeyer, Y. S. Zhang, L. Zhang and B. K. Hollenbeck J Urol 2010; 184: 2480 –2484.
To the Editor: I am writing this Letter on behalf of the members of the American Association of Clinical Urologists (AACU). As physicians, we take pride in our calling. It is an honor and a privilege to improve the lives of our patients and treat them to the best of our ability and in the manner that our training and ethics require. This being said, we are disappointed with the authors’ suggestion that salaried physicians derive no financial benefit from providing more care. This article attempts to directly link increased imaging use to urologists who are self-employed. The AACU believes this article attacks the character and motivations of practicing urologists. Many salaried, employed, academic physicians are supported by their department or employer’s clinical income. This clinical income to pay salaries is driven in large part by the services that those hospitals or academic centers provide. Additionally, many salaried employees also receive bonus income based on the margins of their employer. Their estimate based on the National Ambulatory Medical Care Survey (NAMCS) was 28% with a tie to volume but with a standard error of