Additional studies are warranted to investigate the role of the urinary CRP level in LUTS. Chun-Hou Liao, M.D. Division of Urology Department of Surgery Cardinal Tien Hospital College of Medicine, Postdoctoral Program in Nutrition and Food Sciences Graduate Institute of Basic Medicine Fu Jen Catholic University Taipei, Taiwan Hann-Chorng Kuo, M.D. Department of Urology Buddhist Tzu Chi General Hospital and Tzu Chi University Hualien, Taiwan References 1. Chung SD, Liu HT, Lin H, et al. Elevation of serum C-reactive protein in patients with OAB and IC/BPS implies chronic in- flammation in the urinary bladder. Neurourol Urodyn. 2011;30: 417-420. 2. Kupelian V, Rosen RC, Roehrborn CG, et al. Association of over- active bladder and C-reactive protein levels. Results from the Boston Area Community Health (BACH) Survey. BJU Int. In press. 3. Liao CH, Chung SD, Kuo HC. Serum C-reactive protein levels are associated with residual urgency symptoms in patients with benign prostatic hyperplasia after medical treatment. Urology. 2011;78: 1373-1378. 4. Chuang YC, Tyagi V, Liu RT, et al. C-reactive protein levels as potential biomarkers of lower urinary tract symptoms. Urol Sci. 2010;21:132-136. 5. Liu HT, Kuo HC. Urinary nerve growth factor levels are increased in patients with bladder outlet obstruction with overactive bladder symptoms and reduced after successful medical treatment. Urology. 2008;72:104-108. Re: Rourke et al.: Effect of Wound Closure on Buccal Mucosal Graft Harvest Site Morbidity: Results of a Randomized Prospective Trial (Urology 2012;79:443-447) TO THE EDITOR: We congratulate the authors on conducting a randomized prospective trial that suggests that leaving the buccal mucosa graft harvest site open (compared with closure of the donor site) leads to lower early pain scores, an earlier return to a full diet, an earlier return to full mouth opening, and a decrease in bothersome perioral numbness postoperatively. Their results are similar to our published data 1 (nonrandomized). The authors mention the use of bipolar electrocautery for hemostasis. However, we have found that with dis- section in the correct plane and using our technique with the patient under local anesthesia, 2 we have never needed to use cautery. We have performed buccal muco- sal graft urethroplasty for male and female urethral stric- tures and small segment ureteral strictures with good results and low donor site morbidity. However, in the world of evidence-based medicine, the authors’ results seem more acceptable because their study was statistically better powered and was prospective and randomized. We accept their results and would like to conduct a similar study of our patients in the future. Swarnendu Mandal, M.S. Vishwajeet Singh, M.S., M.Ch. Satyanarayan Sankhwar, M.S., M.Ch. Department of Urology Chhatrapati Shahuji Maharaj Medical University (Formerly, King George Medical College) Lucknow, India References 1. Sinha RJ, Singh V, Sankhwar SN, et al. Donor site morbidity in oral mucosa graft urethroplasty: implications of tobacco consumption. BMC Urol. 2009;21:1-7. 2. Goel A, Dalela D, Sinha RJ, et al. Harvesting buccal mucosa graft under local infiltration analgesia—mitigating need of general anaes- thesia. Urology. 2008;72:675-676. Re: Binbay et al.: Does Pelvicaliceal System Anatomy Affect Success of Percutaneous Nephrolithotomy? (Urology 2011;78:737-738) TO THE EDITOR: We read with great interest this article on the risk factors for residual stones after percutaneous nephrolithomy (PCNL). The authors have looked into the variables of pelvicaliceal system (PCS) anatomy to predict success or failure of the procedure. The authors reported that only 2 parameters predicted the success rate: staghorn type of stone and the PCS surface area. In our opinion, these are confounding variables because they address the same parameter. As the stone size increases, there is always a simultaneous increase in the size of the PCS. In fact, there were 58.7% patients with staghorn type of stone in patients with PCNL failure (where the PCS surface area was also found to be large) compared with only 21.1% of patients in the group with PCNL success. In our opinion, the larger surface of the PCS is not an independent risk factor for the failure of PCNL. The authors have rea- soned that the lower success rate in larger systems is caused by: (1) Difficulty in reaching stones located in other calices through a single access point; (2) short size of equipment, especially in the obese; (3) need for mul- tiple punctures; (4) ineffectiveness of a flexible nephro- UROLOGY 79 (5), 2012 1193