Factors influencing fluid intake behavior among kidney stone formers.

PURPOSE: We determined factors influencing the behavior of patients with kidney stones in the prevention of recurrent stones. MATERIALS AND METHODS: Patients with stones from an academic and a community practice were recruited for key informant interviews and focus groups. Groups were guided based on the framework of the health belief model. Content analysis was done on transcriptions using qualitative data analysis software. RESULTS: Key informant interviews were completed with 16 patients and with a total of 29 subjects in 5 focus groups. Content analysis revealed that patients were highly motivated to prevent stones. The minimum level of perceived benefit for adopting the behavior change varied among patients and the behaviors proposed. An important strategy to increase fluid intake was insuring availability with containers. Patients were more consistently confident in the ability to increase fluid, in contrast to ingesting medicine or changing the diet. While barriers to increasing fluid were multifactorial among individuals, the barriers aligned into 3 progressive stages that were associated with distinct patient characteristics. Stage 1 barriers included not knowing the benefits of fluid or not remembering to drink. Stage 2 barriers included disliking the taste of water, lack of thirst and lack of availability. Stage 3 barriers included the need to void frequently and related workplace disruptions. CONCLUSIONS: Patients with kidney stones are highly motivated to prevent recurrence and were more amenable to fluid intake change than to another dietary or pharmaceutical intervention. Barriers preventing fluid intake success aligned into 3 progressive stages. Tailoring fluid intake counseling based on patient stage may improve fluid intake behavior.

Predictors of Reporting Success With Increased Fluid Intake Among Kidney Stone Patients.

OBJECTIVE: To determine how kidney stone patients' knowledge, behaviors, and preferences toward fluid intake differed from those reporting being successful or unsuccessful at increasing fluid intake for prevention. MATERIALS AND METHODS: Three hundred two kidney stone patients filled out a survey on stone history, fluid intake success, and knowledge, behaviors, and preferences toward fluid intake. Responses were compared between those reporting being very successful at fluid intake and those reporting being not successful or only somewhat successful. Self-reported fluid intake success was correlated in a subset of 41 subjects using 24-hour urine volumes. RESULTS: Self-reported fluid intake success correlated significantly with 24-hour urine volumes. Unsuccessful fluid drinkers were less likely to be aware of their future stone risk and were less likely to be counseled on prevention by a urologist. Successful fluid drinkers reported the fewest barriers per person, were more likely to prefer water for fluid intake, and were more likely to like the "taste" of water. Strategies used for remembering to drink varied significantly with those unsuccessful most often reporting "just tried to remember" and those successful at fluid intake most likely to carry a water bottle. All groups reported similar perceived severity from stones, perceived benefits of drinking fluids, and preference for using urine color to monitor hydration. CONCLUSION: Awareness of future stone risk, preference for water, counseling on stone prevention by a urologist, and specific strategies used for increasing fluid intake varied between patients who were successful or unsuccessful with fluid intake. Addressing these differences may help improve fluid intake success.

Gender and renal cancer: do variations in clinical presentation and imaging patterns explain observed differences between males and females?

OBJECTIVES: To determine whether gender variations in imaging and healthcare access are contributing to observed differences in renal cancer, we examine the initial events in the diagnosis of renal masses in a cohort of patients and correlate it with detailed data on imaging patterns over the same period. METHODS: A total of 308 patients diagnosed with a renal mass over 11 years were reviewed. Information on symptoms, imaging, diagnosing physician, demographics, and pathology was gathered. Data on imaging for 1 862 485 patients at our institution over the same period were also collected. The data were analyzed for temporal trends, gender variations, and differences between incidental and nonincidental masses. RESULTS: Females presented with smaller masses (4.8 vs 6.0 cm, P = .0064), and were less likely to have clear cell tumors (58.7% vs 63.4%, P = .049). A total of 66.9% of female and 61.1% of male cases were incidental (not significant). In both males and females, primary care physicians were the most common diagnosing physicians (47.4% and 49.6%, respectively). Gynecologic complaints were an uncommon cause of diagnosis for women (5.3%). Computerized tomography was the most common diagnosing modality for both males and females (69.1% and 63.2%, respectively). Ultrasound as the diagnosing modality did not reach statistical significance between males and females (23.4% and 28.6%, respectively). During the 11- year period, women underwent more imaging studies overall than men (19.7% difference), but the difference was lower when only considering studies that can diagnose renal masses (6.4% difference). CONCLUSIONS: Gender variations in imaging rates and presentation for obstetrics/gynecology concerns by females did not lead to a significant difference in incidental diagnosis and do not appear adequate to explain gender differences in renal cancer presentation.

Laparoscopic radical adrenalectomy for cancer: long-term outcomes.

PURPOSE OF REVIEW: Laparoscopic adrenalectomy for malignant adrenal masses has been controversial because of initial reports of high rates of local recurrence and carcinomatosis. With additional experience, improved outcomes have been reported. We evaluate the contemporary role of laparoscopy in treating adrenal malignancies. RECENT FINDINGS: Several contemporary reports now demonstrate that laparoscopic adrenalectomy for primary adrenal malignancy can provide oncologic outcomes equivalent to open surgery without an increased risk of carcinomatosis or port site recurrence. Although long-term survival of 47 months with no recurrence has been reported, the underlying aggressiveness of this tumor has contributed to a 39.6% rate of recurrence for the 48 contemporary cases reviewed in this article. This compares favorably to open series that report a similar or higher recurrence rate. When utilized for the treatment of solitary metastases to the adrenal gland, laparoscopic adrenalectomy provides equivalent oncologic outcomes to open adrenalectomy. SUMMARY: Laparoscopic adrenalectomy for malignancy can be performed in appropriately selected cases with equal oncologic outcomes to open approaches while providing advantages in patient morbidity. Caution must be taken to avoid tumor entry or spillage because of the potential for local recurrence, port site recurrence, and carcinomatosis that can occur with these aggressive tumors.