Prevalence of undiagnosed and inadequately treated type 2 diabetes mellitus, hypertension, and dyslipidemia in morbidly obese patients who present for bariatric surgery.

BACKGROUND: Pharmacotherapy is considered the primary treatment modality for diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DYS). We sought to investigate the status of DM, HTN, and DYS in patients who seek bariatric surgery. METHODS: Demographic and comorbidity history were prospectively collected on 1,508 patients referred for bariatric consultation at a single institution from February 2008 to March 2012. We utilized published consensus guidelines (GL) to benchmark the efficacy of standard pharmacotherapy for these metabolic diseases, and 881 patients met the study design criteria. RESULTS: Most patients exhibited at least one form of metabolic dysregulation (pre-DM or DM, 75.8%; pre-HTN or HTN, 91.1%; pre-DYS or DYS, 84.0%; metabolic syndrome, 76.0%). The majority of patients either did not meet GL treatment goals (DM, 45.7%; HTN, 39.5%; DYS, 22.3%) or were previously undiagnosed (DM, 15.8%; HTN, 13.7%; DYS, 41.7%). Non-GL pharmacotherapy was significantly less effective than GL pharmacotherapy at achieving treatment goals for DM (31.8 vs. 53.2%, p < 0.001) and HTN (43.6 vs. 63.2%, p = 0.007). Patients with concurrent DM, HTN, and DYS (35.5%) were less likely than patients with only one or two of these metabolic diseases to achieve GL treatment goals for HTN (38.1 vs. 72.6%, p < 0.001) and DYS (55.7 vs. 73.8%, p = 0.002). Only 8.0% of these patients achieved treatment goals for all three metabolic comorbidities. CONCLUSIONS: In this patient group, DM, HTN, and DYS were poorly compensated, even when pharmacotherapy was consistent with published GL. This may be due to disease burden in bariatric surgery candidates or to inadequate medical management prior to presentation.

Internet survey of management trends of urethral strictures.

OBJECTIVES: The management of urethral stricture is often complex and the decision to proceed to urethroplasty may be difficult. A variety of factors are used by urologists to help guide this decision. We sought to conduct a survey to define current management trends and referral patterns in the treatment of urethral stricture disease. METHODS: An internet survey was conducted using the email directory for the AUA North Central Section. Survey design focused on urologist demographics and practice type, practice trends for treating urethral strictures, and referral patterns. Results were analyzed to assess for demographic parameters influencing management and referral trends. RESULTS: Responses were received from 84/600 (14%) urologists. Despite 95% of respondents reporting the recent treatment of urethral stricture, the majority of urologists reported performing no urethroplasties within the same time period. Complicated repairs (posterior, buccal) were performed by only a few of the respondents. A variety of factors were used by urologists to help decide at what point urethroplasty should be pursued. However, the importance of these factors varied significantly. CONCLUSIONS: Our data suggest that the treatment algorithm for urethral strictures is complex and varies considerably between urologists. The decision to perform urethroplasty may be particularly difficult. Finally, patient referral appears to play a significant role in stricture management. Treatment guidelines based on objective data are needed.