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1.
Urology ; 130: 53, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31345298
2.
Int. braz. j. urol ; 45(3): 572-580, May-June 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1012316

RESUMO

ABSTRACT Purpose: To better characterize metabolic stone risk in patients with neurologically derived musculoskeletal deficiencies (NDMD) by determining how patient characteristics relate to renal calculus composition and 24-hour urine parameters. Materials and Methods: We performed a retrospective cohort study of adult patients with neurologically derived musculoskeletal deficiencies presenting to our multidisciplinary Kidney Stone Clinic. Patients with a diagnosis of NDMD, at least one 24-hour urine collection, and one chemical stone analysis were included in the analysis. Calculi were classified as primarily metabolic or elevated pH. We assessed in clinical factors, demographics, and urine metabolites for differences between patients who formed primarily metabolic or elevated pH stones. Results: Over a 16-year period, 100 patients with NDMD and nephrolithiasis were identified and 41 met inclusion criteria. Thirty percent (12 / 41) of patients had purely metabolic calculi. Patients with metabolic calculi were significantly more likely to be obese (median body mass index 30.3kg / m2 versus 25.9kg / m2), void spontaneously (75% vs. 6.9%), and have low urine volumes (100% vs. 69%). Patients who formed elevated pH stones were more likely to have positive preoperative urine cultures with urease splitting organisms (58.6% vs. 16.7%) and be hyperoxaluric and hypocitraturic on 24-hour urine analysis (37mg / day and 265mg / day versus 29mg / day and 523mg / day). Conclusions: Among patients with NDMD, metabolic factors may play a more significant role in renal calculus formation than previously believed. There is still a high incidence of carbonate apatite calculi, which could be attributed to bacteriuria. However, obesity, low urine volumes, hypocitraturia, and hyperoxaluria suggest an underrecognized metabolic contribution to stone formation in this population.

3.
Urology ; 131: 53-56, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31132426

RESUMO

OBJECTIVE: To characterize current practice patterns of urologists in the management of intravenous (IV) contrast allergy in the setting of endourologic procedures. METHODS: A survey was administered to all members of the Endourological Society to assess management of IV contrast allergy prior to ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL). Treatment regimens, reports of adverse outcomes, and demographics of respondents were also collected. Data were analyzed using chi-square tests. RESULTS: The response rate was 15% (325/2100). A total of 21% and 28% of respondents reported giving prophylaxis prior to URS and PCNL, respectively. Nearly 3% of respondents reported having observed a severe adverse reaction to intraluminal contrast in the past. Approximately half reported giving prophylaxis only 1 hour prior to the procedure. Most respondents (77%) completed a fellowship, the most common being endourology. Chi-square analysis revealed a significant difference between giving prophylaxis for URS or PCNL and the respective case volumes (for URS, X2 = 8.3, P= .004; for PCNL, X2 = 8.5, P= .003) where urologists with the lowest and highest case volumes were more likely to give prophylaxis (Fig. 1). There was no significant difference between giving prophylaxis for URS or PCNL and recency of residency, fellowship training, practice setting, or practice type. CONCLUSION: Most urologists do not give prophylaxis for patients with IV contrast allergy prior to URS and PCNL. Further studies are needed to evaluate the necessity of prophylaxis as well as to establish clear guidelines.

4.
Urology ; 130: 48-53, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31026476

RESUMO

OBJECTIVE: To model the risk of secondary malignancy and associated mortality due to ionizing radiation from the evaluation and management of nephrolithiasis. METHODS: A PUBMED-based literature search was performed to identify model inputs, specifically annual incidence of nephrolithiasis sub-stratified by age and gender and radiation exposure associated with nephrolithiasis episodes. Estimates of age and gender specific radiation-induced malignancy and mortality rates were obtained from the BEIR VII Phase 2 report with dose extrapolation using the linear no-threshold model. RESULTS: Incidence of new diagnoses of nephrolithiasis ranged from 42/100,000 in males 20-30 years old to 248/100,000 in males 60-70 years old. Radiation exposure per nephrolithiasis episode was 37.3 mSv over a 2-year period. Data regarding average stone episodes per patient with nephrolithiasis was limited and conservatively estimated at 1.5. Modeled lifetime attributable risk of secondary malignancy and subsequent mortality in individual stone patients ranged from 0.096% and 0.085%, respectively, in males over the age of 70 to 0.59% and 0.39% in females 20-30 years old. In the USA, overall incidence of secondary malignancy and associated mortality related to nephrolithiasis management was calculated to be 862.7 and 545.3 cases/year, respectively. CONCLUSION: This model suggests that ionizing radiation from the management of nephrolithiasis carries a small but significant risk of causing secondary malignancy. This knowledge must be considered when using modalities that involve radiation in the diagnosis and therapeutic management of nephrolithiasis.

5.
Int Braz J Urol ; 45(3): 572-580, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30676304

RESUMO

PURPOSE: To better characterize metabolic stone risk in patients with neurologically derived musculoskeletal deficiencies (NDMD) by determining how patient characteristics relate to renal calculus composition and 24-hour urine parameters. MATERIALS AND METHODS: We performed a retrospective cohort study of adult patients with neurologically derived musculoskeletal deficiencies presenting to our multidisciplinary Kidney Stone Clinic. Patients with a diagnosis of NDMD, at least one 24-hour urine collection, and one chemical stone analysis were included in the analysis. Calculi were classified as primarily metabolic or elevated pH. We assessed in clinical factors, demographics, and urine metabolites for differences between patients who formed primarily metabolic or elevated pH stones. RESULTS: Over a 16-year period, 100 patients with NDMD and nephrolithiasis were identified and 41 met inclusion criteria. Thirty percent (12 / 41) of patients had purely metabolic calculi. Patients with metabolic calculi were significantly more likely to be obese (median body mass index 30.3kg / m2 versus 25.9kg / m2), void spontaneously (75% vs. 6.9%), and have low urine volumes (100% vs. 69%). Patients who formed elevated pH stones were more likely to have positive preoperative urine cultures with urease splitting organisms (58.6% vs. 16.7%) and be hyperoxaluric and hypocitraturic on 24-hour urine analysis (37mg / day and 265mg / day versus 29mg / day and 523mg / day). CONCLUSIONS: Among patients with NDMD, metabolic factors may play a more significant role in renal calculus formation than previously believed. There is still a high incidence of carbonate apatite calculi, which could be attributed to bacteriuria. However, obesity, low urine volumes, hypocitraturia, and hyperoxaluria suggest an underrecognized metabolic contribution to stone formation in this population.


Assuntos
Cálculos Renais/química , Cálculos Renais/urina , Doenças Musculoesqueléticas/urina , Doenças do Sistema Nervoso/urina , Adulto , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/etiologia , Doenças do Sistema Nervoso/complicações , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
6.
Can J Urol ; 25(1): 9154-9160, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29524969

RESUMO

INTRODUCTION: The risks of exposure to medical ionizing radiation is of increasing concern both among medical professionals and the general public. Patients with nephrolithiasis are exposed to high levels of ionizing radiation through both diagnostic and therapeutic modalities. Endourologists who perform a high-volume of fluoroscopy guided procedures are also exposed to significant quantities of ionizing radiation. The combination of judicious use of radiation-based imaging modalities, application of new imaging techniques such as ultra-low dose computed tomography (CT) scan, and modifying use of current technology such as increasing ultrasound and pulsed fluoroscopy utilization offers the possibility of significantly reducing radiation exposure. We present a review of the literature regarding the risks of medical ionizing radiation to patients and surgeons as it pertains to the field of endourology and interventions that can be performed to limit this exposure. MATERIALS AND METHODS: A review of the current state of the literature was performed using MEDLINE and PubMed. Interventions designed to limit patient and surgeon radiation exposure were identified and analyzed. Summaries of the data were compiled and synthesized in the body of the text. RESULTS: While no level 1 evidence exists demonstrating the risk of secondary malignancy with radiation exposure, the preponderance of evidence suggests a dose and age dependent increase in malignancy risk from ionizing radiation. Patients with nephrolithiasis were exposed to an average effective dose of 37mSv over a 2 year period. Multiple evidence-based interventions to limit patient and surgeon radiation exposure and associated risk were identified. CONCLUSION: Current evidence suggest an age and dose dependent risk of secondary malignancy from ionizing radiation. Urologists must act in accordance with ALARA principles to safely manage nephrolithiasis while minimizing radiation exposure.

7.
Urology ; 103: 63-67, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28126487

RESUMO

OBJECTIVE: To evaluate the effect of 1 pulse-per-second (pps) fluoroscopy on fluoroscopy time and surgeon radiation exposure during ureteroscopy. MATERIALS AND METHODS: A retrospective review of a single endourologist's operative records was performed over a 12-month period. Adult patients undergoing ureteroscopy were included. At the 6-month point, the switch from continuous "low-dose" to 1 pps "low-dose" fluoroscopy was made. Surgeon radiation exposure was measured using 1 dosimeter placed at the torso under the lead apron and 1 dosimeter overlying the chest outside the lead apron. RESULTS: A total of 84 and 70 patients underwent ureteroscopy using continuous and 1 pps fluoroscopy, respectively. No differences were identified between the 2 groups with regard to patient age (P = .96), sex (P = .26), body mass index (P = .95), stone multiplicity (P = .31), bilateral ureteroscopy (P = .07), pre-stenting (P = .99), staged (P = .84) or failed (P = .99) primary ureteroscopy, ureteral access sheath utilization (P = .10), or case duration (P = .54). Patients in the 1 pps cohort had a larger median stone burden (P = .04). The median fluoroscopy time was reduced from 77 (interquartile range: 54-115) to 16 seconds (interquartile range: 13-24) using 1 pps fluoroscopy (P < .001). Monthly surgeon radiation exposure was reduced by 64%, from 6.8 ± 8.3 to 1.8 ± 2.7 mRad deep dose equivalent (P = .11), from 120.6 ± 101.4 to 49.2 ± 66.6 mRad lens dose equivalent (P = .10), and from 116.2 ± 97.8 to 47.6 ± 64.0 mRad shallow dose equivalent (P = .11). Reversion to continuous fluoroscopy was never required during the study period. CONCLUSION: Single pps fluoroscopy is feasible, significantly reduces fluoroscopy time, and lowers surgeon radiation exposure by 64%.


Assuntos
Fluoroscopia/métodos , Ureteroscopia/métodos , Adulto , Idoso , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Exposição à Radiação , Radiometria , Estudos Retrospectivos , Fatores de Tempo
8.
J Urol ; 197(4): 1079-1083, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27765695

RESUMO

PURPOSE: Vitamin D deficiency is often detected during metabolic evaluation in the nephrolithiasis population. Multiple vitamin D repletion protocols exist, although their differing impact on urinary stone formation risk factors is unclear. MATERIALS AND METHODS: Patients with a history of calcium stones and vitamin D deficiency (less than 30 ng/ml) were randomized to receive either 1,000 IU daily or 50,000 IU weekly of vitamin D supplementation for 6 weeks. Patients completed a pretreatment and posttreatment serum vitamin D level evaluation and 24-hour urine collections to assess the response and any changes in urine stone formation risk parameters. RESULTS: A total of 21 patients completed the study, including 8 who received 1,000 IU daily and 13 who received 50,000 IU weekly. The 50,000 IU weekly group showed a significant increase in median serum vitamin D levels of 23 ng/ml (135%, p <0.01), while the 1,000 IU daily group showed a nonsignificant median increase of 9 ng/ml (49%, p = 0.12). Post-repletion 24-hour urine analysis demonstrated no significant change in urine calcium between the groups, including a median change of -11 mg (IQR -143-29) in patients receiving 1,000 IU and -16 mg (IQR -42-66) in those receiving 50,000 IU. Between the groups there was no significant difference in the supersaturation of calcium oxalate or calcium phosphate. CONCLUSIONS: High dose and low dose vitamin D repletion had no effect on urine calcium excretion or the supersaturation of calcium salts in known stone formers. The higher dosing regimen, which had superior repletion, may be the optimal protocol in patients with vitamin D deficiency.

9.
J Endourol ; 30(9): 970-4, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27301268

RESUMO

PURPOSE: Primary ureteroscopic intervention for kidney or ureteral stones occasionally encounters difficulty with passage of the ureteroscope in the initial procedure. These patients require a second procedure after stenting. We aim to define the contemporary failure rate of primary ureteroscopy (URS) and identify predictive factors that necessitate prestenting. This will assist in preoperative patient counseling, informed consent, and clinical decision-making. MATERIALS AND METHODS: We conducted a multi-institutional retrospective review of 535 unstented patients undergoing primary URS from August 2011 to August 2013. The primary outcome was gaining access to the unstented ureter. RESULTS: The failure rate for accessing the unstented ureter was 7.7% (41/535). The median age of females with primary ureteroscopic failure was significantly lower than in females who had successful ureteroscopic access (34 vs 52 years; p = 0.0041). There was no difference in the median age of males with access vs failure (58 vs 57 years; p = 0.3683). Proximal ureteral stones had the highest failure rate for ureteral access at 18.28% (p = 0.006). On multivariable logistic regression, proximal ureteral stone location remained a significant predictor of failure when compared to renal stones (odds ratio [OR] 3.14, p = 0.006). When including only ureteral stones in the multivariable analysis, stone location in the proximal ureter compared to the distal ureter remained the only significant predictor of access failure (OR 0.24, p = 0.015). CONCLUSIONS: A low overall rate of ureteral access failure in unstented patients is shown. Young female patients and proximal ureteral stones were less likely to be accessed primarily. This study provides information that will help urologists counsel their patients preoperatively regarding their likelihood of failing primary URS necessitating a second procedure. This will also help the patient to make an informed decision during the consent process and may guide urologists on selective prestenting in higher risk patients.


Assuntos
Cálculos Renais/cirurgia , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Cálculos Renais/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Stents , Falha de Tratamento , Resultado do Tratamento , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/patologia , Ureteroscópios
11.
J Urol ; 193(1): 165-9, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25014576

RESUMO

PURPOSE: Flexible ureteroscopy is rapidly becoming a first line therapy for many patients with renal and ureteral stones. However, current understanding of treatment outcomes in patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones smaller than 2 cm to better define clinical outcomes associated with this approach. MATERIALS AND METHODS: Adult patients with proximal ureteral calculi smaller than 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded from study. Flexible ureteroscopy, holmium laser lithotripsy and ureteral stent placement was performed. Ureteral access sheath use, laser settings and other details of perioperative and postoperative management were based on individual surgeon preference. Stone clearance was determined by the results of renal ultrasound and plain x-ray of the kidneys, ureters and bladder 4 to 6 weeks postoperatively. RESULTS: Of 71 patients 44 (62%) were male and 27 (38%) were female. Mean age was 48.2 years. ASA(®) score was 1 in 12 cases (16%), 2 in 41 (58%), 3 in 16 (23%) and 4 in 2 (3%). Mean body mass index was 31.8 kg/m(2), mean stone size was 7.4 mm (range 5 to 15) and mean operative time was 60.3 minutes (range 15 to 148). Intraoperative complications occurred in 2 patients (2.8%), including mild ureteral trauma. Postoperative complications developed in 6 patients (8.7%), including urinary tract infection in 3, urinary retention in 2 and flash pulmonary edema in 1. The stone-free rate was 95% and for stones smaller than 1 cm it was 100%. CONCLUSIONS: Flexible ureteroscopy is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones smaller than 2 cm.


Assuntos
Cálculos Ureterais/cirurgia , Ureteroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cálculos Ureterais/patologia
12.
Nat Rev Urol ; 11(3): 163-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24515090

RESUMO

Kidney stones affect 10% of people at some point in their lives and, for some unfortunate women, this happens during pregnancy. Pregnancy is a complex state and both physiological and mechanical changes alter risk factors for kidney stone formation. When a pregnant woman develops acute nephrolithiasis, the situation is more complicated than in nonpregnant women. Imaging limitations and treatment restrictions mean that special diagnostic and management algorithms are needed upon presentation. Ultrasonography remains the gold-standard first-line diagnostic imaging modality for kidney stones during pregnancy but several second-line alternatives exist. Acute renal colic during pregnancy is associated with risks to both mother and fetus. As such, these patients need to be handled with special attention. First-line management is generally conservative (trial of passage and pain management) and is associated with a high rate of stone passage. Presentation of obstructive nephrolithiasis with associated infection represents a unique and serious clinical situation requiring immediate drainage. If infection is not present and conservative management fails, ureteroscopy can be offered if clinically appropriate, but, in some circumstances, temporary drainage with ureteral stent or nephrostomy tube might be indicated. Shockwave lithotripsy and percutaneous nephrolithotomy are contraindicated during pregnancy.


Assuntos
Cálculos Renais , Complicações na Gravidez , Feminino , Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/etiologia , Cálculos Renais/terapia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Complicações na Gravidez/terapia , Resultado da Gravidez , Fatores de Risco
13.
Can J Urol ; 21(1): 7151-3, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24529020

RESUMO

Serious complications of shock wave lithotripsy (SWL) are rare, but can have significant long term effects. We present a case of acute renal vein thrombus following SWL leading to subsequent renal atrophy and loss of renal function. To our knowledge this is a newly reported complication of SWL.


Assuntos
Cálculos Renais/terapia , Rim/patologia , Litotripsia/efeitos adversos , Veias Renais , Trombose Venosa/etiologia , Doença Aguda , Atrofia/diagnóstico por imagem , Atrofia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia
14.
Adv Chronic Kidney Dis ; 20(3): 260-4, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23928391

RESUMO

Kidney stones are common and do not spare the pregnant population. Although a simple stone event is usually straightforward in the general population, it is complex during pregnancy. Acute nephrolithiasis is associated with a unique set of complications during pregnancy and, because of imaging limitations, diagnosis is challenging. Multidisciplinary care is the key in proper management decisions. The pathophysiology of kidney stone formation in the pregnant state is also unique. Herein, we discuss the complexity of kidney stones and pregnancy.


Assuntos
Cálculos Renais/diagnóstico , Complicações na Gravidez/diagnóstico , Feminino , Humanos , Cálculos Renais/terapia , Gravidez , Complicações na Gravidez/terapia
15.
Urology ; 82(3): 547-51, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23845668

RESUMO

OBJECTIVE: To determine International Classification of Disease, 9th Revision, (ICD-9) coding patterns as a proxy for incidence and prevalence of urinary incontinence (UI) in a population of patients before and after a bariatric surgical procedure for the treatment of obesity. METHODS: We evaluated claims from a national private insurer over a 5-year period (2002-2006) to identify female patients who underwent bariatric surgery and had 3 years of follow-up claims data. The cohort of patients who underwent bariatric surgery (treatment) was matched to a cohort of obese female patients who did not undergo bariatric surgery (control), who were followed from the start of their enrollment. UI was identified by ICD-9 coding. RESULTS: After bariatric surgery, 62.4% of patients (83/133) diagnosed with UI before their surgery no longer had a coding diagnosis of UI. In contrast, only 42.1% (56/133) of those in the nonbariatric surgery cohort lost their coding diagnosis of UI (P = .0009). Of those that did not have pre-existing UI, 6.2% (235/3765) of the bariatric surgery cohort gained a new coding diagnosis of UI vs 7.1% (269/3765) of the control group (P = .1169). Our final model suggested that age >45 years (P <.0001) and pre-existing UI (P <.0001) were significantly associated with post-index date UI. Interaction between bariatric surgical status and UI was also significant (P <.0001). CONCLUSION: Patients who undergo bariatric surgery are more likely to lose a previous diagnosis of UI than are obese patients not treated with bariatric surgery. This supports the fact that bariatric surgery may have other indirect benefits to the obese population.


Assuntos
Cirurgia Bariátrica , Obesidade/cirurgia , Incontinência Urinária/epidemiologia , Perda de Peso , Adulto , Fatores Etários , Cirurgia Bariátrica/efeitos adversos , Feminino , Humanos , Incidência , Classificação Internacional de Doenças , Pessoa de Meia-Idade , Obesidade/complicações , Prevalência , Estados Unidos/epidemiologia , Incontinência Urinária/etiologia , Incontinência Urinária/terapia
16.
Urology ; 79(6): 1252-5, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22446340

RESUMO

OBJECTIVE: To report our experience with magnetic resonance urography (MRU) in pregnant women suspected of having obstructing upper tract calculi. The diagnosis of an upper tract calculus in the pregnant woman can be challenging. Recent evidence suggests that MRU can be used to effectively evaluate renal colic. METHODS: From 2008-2011, 9 pregnant women were referred for evaluation of suspected renal colic caused by an obstructing upper tract stone. All patients underwent MRU with a half Fourier single-shot turbo spin-echo (HASTE) protocol. Medical records and imaging studies were reviewed for demographic and clinical data as well as outcome measures. RESULTS: The mean age of the subjects was 25 years (range 20-34); average gestational age of the fetus was 23 weeks (range 9-36). In all cases, a renal ultrasound was the initial imaging study obtained, with nondiagnostic findings. HASTE MRU detected 4 ureteral stones and 4 cases of physiological hydronephrosis of pregnancy. In one case, interpretation of the MRU was limited as a result of patient motion. Of the patients with obstructing stones, 1 required endourologic management during her pregnancy and 3 were followed conservatively. No adverse events related to MRU occurred. CONCLUSION: HASTE MRU is an informative imaging study for pregnant women with suspected upper tract stone disease. Information gathered from this study augments that gained from alternative modalities, and aids in medical decision-making. The lack of ionizing radiation exposure, coupled with the capture of detailed anatomic imaging, makes HASTE MRU a particularly useful study in this setting.


Assuntos
Rim/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Complicações na Gravidez/diagnóstico , Cólica Renal/diagnóstico , Adulto , Feminino , Humanos , Hidronefrose/diagnóstico , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Cólica Renal/etiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Cálculos Ureterais/complicações , Urografia/métodos , Adulto Jovem
17.
Urology ; 79(2): 266-9, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22130358

RESUMO

OBJECTIVE: To perform a study to describe the way in which an increasingly obese body mass index (BMI) is associated with urinary tract infection (UTI). The association between UTI and obesity is not well characterized. In fact, previous investigations of this subject have yielded conflicting findings. UTI is increasingly being recognized as a preventable complication, and UTI rates are used to measure quality of surgical care. MATERIALS AND METHODS: We evaluated claims over a 5-year period (2002-2006) in a national private claims database to identify patients diagnosed with UTI or pyelonephritis by ICD-9 coding. Descriptive analyses were performed and odds ratios were calculated. RESULTS: A total of 95,598 subjects were identified for evaluation. Gender distribution was 42.9% male and 57.1% female. In the overall study cohort, the diagnosis of a UTI or pyelonephritis occurred in 13% and 0.84%, respectively. Women were 4.2 times more likely to be diagnosed with a UTI (19.3% vs 4.6%), and 3.6 times more likely to be diagnosed with pyelonephritis (1.22% vs 0.34%), than were men. At all stratifications of obesity, the obese were significantly more likely to be diagnosed with a UTI or pyelonephritis than nonobese patients. CONCLUSION: Elevated BMI appears to be associated with an increased risk for UTI and pyelonephritis. Further study is needed to determine whether this association may be attributed to a cause-and-effect relationship. However, these results may serve to guide clinicians who treat obese patients, because it may be an additional benefit of weight loss.


Assuntos
Obesidade/epidemiologia , Infecções Urinárias/epidemiologia , Índice de Massa Corporal , Estudos de Coortes , Comorbidade , Estudos Transversais , Cistite/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pielonefrite/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Estados Unidos/epidemiologia
19.
Urology ; 78(5): 1178-81, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21550644

RESUMO

An infant born at 38-weeks' gestation presented with ambiguous genitalia. Cytogenetic evaluation revealed an uncommon 45,X/46,X,idic(Y) mosaic karyotype. Pelvic ultrasonography, genitogram, and magnetic resonance imaging confirmed a long common urogenital sinus, vagina, cervix, unicornuate uterus, phallus, and bilateral intra-abdominal gonads resembling testes. The parents chose a male sex of rearing, and the infant underwent total abdominal hysterectomy, vaginectomy, bilateral gonadectomy, and first-stage hypospadias repair at 19 months of age. The histopathologic findings were consistent with ovotesticular disorder of sex development with a unique combination of testis and ovary on the left and testis and streak gonad on the right.


Assuntos
Mosaicismo , Transtornos Ovotesticulares do Desenvolvimento Sexual/genética , Humanos , Recém-Nascido , Cariótipo , Masculino
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