[Prevention of recurrence of urolithiasis]. / Rezidivprävention der Urolithiasis.

Urolithiasis is one of the most frequent urological diseases. Identifying the causes of stone formation forms the basis for successful prevention of recurrence. Metabolic diagnostics and measures for prevention of recurrence are based on the assignment of the patient to a low-risk or high-risk group. Analysis of the urinary calculi is an essential prerequisite for identifying patients at risk. The general recommendations on diet and lifestyle are considered to be the basis of treatment. Depending on the type of stone and the individual biochemical risk profile of a patient, these general measures should be supplemented by targeted medical nutrition therapy and pharmacological treatment. Mixed stones can pose a challenge for the treatment and prevention of recurrence. A personalized treatment decision that takes the various components of mixed stones into account could further improve the prevention of recurrence of urolithiasis.

Association between neuropathy and B-vitamins: A systematic review and meta-analysis.

BACKGROUND: Peripheral neuropathy (PN) is common in patients with diseases that are in turn associated with deficiency of the B-vitamins, and vitamin treatment has shown mixed results. METHODS: This systematic review and meta-analysis studied the association between PN/pain and B-vitamin biomarkers and investigated whether vitamin treatment can ameliorate the symptoms. PubMed and Web of Science were searched according to the study protocol. RESULTS: A total of 46 observational and seven interventional studies were identified and included in the data synthesis. The presence of PN was associated with lowered B12 levels (pooled estimate [95% CIs] = 1.51 [1.23-1.84], n = 34, Cochran Q Test I2  = 43.3%, p = 0.003) and elevated methylmalonic acid (2.53 [1.39-4.60], n = 9, I2  = 63.8%, p = 0.005) and homocysteine (3.48 [2.01-6.04], n = 15, I2  = 70.6%, p < 0.001). B12 treatment (vs. the comparators) showed a non-significant association with symptom improvement (1.36 (0.66-2.79), n = 4, I2  = 28.9%). Treatment with B1 was associated with a significant improvement in symptoms (5.34 [1.87-15.19], n = 3, I2  = 64.6%, p = 0.059). Analysis of seven trials combined showed a non-significant higher odds ratio for improvement under treatment with the B-vitamins (2.58 [0.98-6.79], I2  = 80.0%, p < 0.001). CONCLUSIONS: PN is associated with lowered plasma vitamin B12 and elevated methylmalonic acid and homocysteine. Overall, interventional studies have suggested that B-vitamins could improve symptoms of PN. Available trials have limitations and generally did not investigate vitamin status prior to treatment. Well-designed studies, especially in non-diabetes PN, are needed. This meta-analysis is registered at PROSPERO (ID: CRD42020144917).