Association of Height and Prevalence of Kidney Stones.

Introduction and objectives Nephrolithiasis is universally understood to be a multifactorial disease resulting from genetic and environmental factors including gender, diet, calcium, and uric acid excretion. Notably, several of these factors may be related to body habitus. Because men are more likely to develop kidney stones and on average have a larger body size, height may be an important risk factor for stone formation. Several studies have demonstrated that short adult stature is associated with numerous conditions such as hypertension, hypercholesterolemia, and cardiovascular diseases. However, other studies have demonstrated otherwise. Additionally, stones have been shown to be correlated with a high body mass index (BMI). This is likely due to dietary factors. Although height is a component of BMI, there is minimal literature regarding the relationship of height to stone prevalence adjusting for weight.  Methods We aimed to examine whether short adult height is associated with the development of kidney stones using a population-based cohort of the National Center for Health Statistics. Data was gathered from National Health and Nutrition Examination Surveys (NHANES) "Kidney Conditions - Urology" and "Weight History" questionnaire datasets from March 2017 to March 2020 along with demographic data. Logistic regression analysis was used to determine an association between current self-reported height (inches) and if the participant has ever had kidney stones, controlling for weight, gender, age, race, educational level, and marital status.  Results We found that those who were shorter had higher odds of reporting a history of stones (OR: 1.017; 95%CI: 1.005-1.028). This association was found after controlling for covariates such as age, gender, race, education, and weight. In addition, the male gender and Hispanic race had higher odds of reporting a history of stones (OR: 1.43 and 1.073, respectively).  Conclusion Our results suggest that short height is related to the prevalence of kidney stones independent of weight, age, gender, and race. This supports previous literature indicating height to be a component of renal disease.

Comparison of the Safety and Efficacy of Valveless and Standard Insufflation During Robotic Partial Nephrectomy: A Prospective, Randomized, Multi-institutional Trial.

OBJECTIVE: To use a randomized, prospective, multi-institutional study to compare the safety and efficacy of conventional insufflation (CIS) and valveless insufflation (AirSeal Insufflation - AIS) at the conventional pressure of 15 mm Hg in robot-assisted partial nephrectomy - a surgery where AIS has gained popularity for maintaining visualization despite suction. This study was also powered to evaluate the effect of decreasing pneumoperitoneum by 20% in the valveless system. MATERIALS AND METHODS: Three high-volume institutions randomized subjects into CIS 15, AIS 15, and AIS 12 mm Hg cohorts. Endpoints included rates of subcutaneous emphysema (SCE), pneumothorax (PTX), pneumomediastinum (PMS), intraoperative end-tidal carbon dioxide (ET CO2), and peak airway pressure (PAP), as well as hospital stay, post-operative pain, and complications. Given the substantial proportion of retroperitoneal surgery, a secondary analysis evaluated the effect of surgical approach. RESULTS: Two hundred and two patients were accrued. SCE was decreased in the AIS 12 mm Hg group (p=0.003). PTX and PMS rates were not statistically significantly different across the 3 insufflation groups. Higher rates of SCE and PMS, although not PTX, were noted in all retroperitoneal surgery groups - with lower SCE rates for AIS 12 mm Hg regardless of surgical approach. CONCLUSION: AIS is often preferred for complex procedures including retroperitoneal and transperitoneal robotic-assisted partial nephrectomy, for its maintenance of pneumoperitoneum despite continuous suction necessary for visualization. This study shows that AIS is safe when compared to CIS at 15 mm Hg, and shows improvement in outcomes when pneumoperitoneum pressure is reduced by 20% to 12 mmHg.

Uretero-Iliac artery fistula: a rare cause of haematuria.

A woman in her mid-forties with a history of cervical cancer requiring chemoradiation presented with bilateral ureteral strictures secondary to radiation therapy. The ureteral obstruction was initially relieved with bilateral percutaneous nephrostomy tubes, and subsequently, bilateral ureteral stents. Over the course of 8 months, she presented with multiple episodes of severe gross haematuria. This persisted even after stent removal and conversion back to percutaneous nephrostomy tubes. The initial evaluation, done with concern for an uretero-iliac artery fistula, which included bilateral retrograde pyelograms and CT angiography was non-diagnostic. Given continued haematuria, repeat endoscopic evaluation was undertaken; on retrograde pyelogram, brisk contrast was seen to pass into the arterial system, consistent with a left ureteroarterial fistula. The patient underwent endovascular iliac artery stent placement. Subsequently, the patient underwent resection of the iliac artery with endovascular graft in situ, left distal ureterectomy with proximal ureteral ligation following femoral-to-femoral bypass. This allowed for complete resolution of the patient's gross haematuria episodes.

Bioregenerative Umbilical Cord Amniotic Membrane Allograft Ureteral Wrap During Robot-Assisted Ureterolysis.

Omental wrap is commonly performed after ureterolysis to prevent ureteral obstruction from recurrence of periureteral adhesions and fibrosis. We present the case of a 37-year-old Caucasian woman with a history of two cesarean sections and laparotomy for the treatment of endometriosis. She subsequently developed right flank pain caused by a right distal ureteral stricture requiring a chronic indwelling ureteral stent. Diagnostic laparoscopy revealed extrinsic compression of the ureter for which robot-assisted ureterolysis was performed. Because of inadequate omentum, we report the initial use of a cryopreserved bioregenerative umbilical cord amniotic membrane allograft to perform a ureteral wrap to promote ureteral tissue healing and serve as an adhesion barrier to prevent recurrence of the fibrosis.

Testosterone therapy in the new era of Food and Drug Administration oversight.

The Food and Drug Administration (FDA) introduced changes in labeling and indications for use to testosterone products in 2015 due to a possible increased risk of cardiovascular (CV) events. This decision was made based on six clinical studies-some that supported an increased CV risk, and some that did not. Since this decision, additional studies have been published examining the interplay between hypogonadism, CV risk, and testosterone, demonstrating that the risk may be lower than originally estimated. Clinicians are placed in a difficult position, as studies support an increased mortality risk in hypogonadal men, but also an increased risk of CV events in men on testosterone therapy. As a result, many clinicians will be more selective in their prescribing of testosterone. In this review, we examine how these new guidelines arose and how they may affect prescribing habits.

Nocturia causes vary with each decade.

PURPOSE OF REVIEW: To review the published literature within the last 18 months that comment on the causes of nocturia, varying with age. The causes are categorized into organized subsets: nocturnal polyuria, storage or reduced bladder capacity, 24-h polyuria, and sleep-associated nocturia. RECENT FINDINGS: Prevalence of nocturia is high, but has been reported at varying rates in the epidemiologic studies. Similarly, reported incidence has a high rate of variability. Nocturia causes were associated with nocturnal polyuria, bladder storage issues, metabolic syndrome, abnormal bowel habits, obesity, Parkinson's disease, global polyuria, insomnia, sleep disturbances, heart failure, anxiety, and depression. Although age was commented on in many articles, it was never the primary examined variable. SUMMARY: There is a lack of standardization in definition and classification of the causes of nocturia. Confounding variables included a lack of use of a standard definition of nocturia, identifying nocturia at its true onset, and a fundamental underutilization of frequency volume charts to identify patients with nocturia. The confounding variables make it difficult to compare studies. Thus, the strength of conclusion on cause will be better defined when standards are set controlling definition, identification, and diagnosis.

Racial disparities in stress test utilization in an emergency department chest pain unit.

BACKGROUND: Epidemiological studies have demonstrated racial disparities in the workup of emergency department patients with chest pain and the referral of admitted patients for intervention. However, little is known about possible disparities in stress test utilization in low-risk chest pain patients admitted to emergency department chest pain units. METHODS: A retrospective observational study of consecutive chest pain unit patients was conducted. Eligibility criteria included age >18 years, American Heart Association low-to-intermediate risk, nondynamic electrocardiograms, and normal initial troponin I. Patients aged >75 years with a history of coronary artery heart disease were excluded. On each patient, we calculated a Thrombolysis in Myocardial Infarction (TIMI) risk prediction score and a Diamond and Forrester (D&F) score for likelihood of coronary artery disease. Two separate multivariate analyses were completed, one including the TIMI score and the other including D&F score, using logistic regression to estimate odds ratios (ORs) for receiving testing based on race, controlling for other relevant covariates. RESULTS: Two thousand four hundred fifty-one patients were enrolled over a planned 1.5-year period. In total, 59.7% [95% confidence interval (CI) 57.8-61.7] of patients were white, 11.6% (95% CI 10.4-12.9) African American, and 28.6% (95% CI 26.9-30.4) "other." The overall stress testing rate was 50.3% (95% CI 48.4-52.3). After controlling for insurance and TIMI or D&F scores, African American patients had significantly decreased odds of stress testing (OR(TIMI) 0.68, 95% CI 0.52-0.89; OR(D&F) 0.67, 95% CI 0.51-0.89). CONCLUSIONS: Our study confirms racial disparities in the utilization of stress testing in the chest pain unit. Further investigation is needed to identify specific provider or patient-level factors that may contribute to this disparity.