Drinking water composition and incidence of urinary calculus: introducing a new index

We searched for a pathophysiologically based feature of major water electrolytes, which may define water quality better than the water hardness, respecting urinary calculus formation. Utilizing a multistage stratified sampling, 2310 patients were diagnosed in the imaging centers of the provincial capitals in Iran between 2007 and 2008. These were composed of 1755 patients who were settled residents of 24 provincial capitals. Data on the regional drinking water composition, obtained from an accredited registry, and their relationships with the region's incidence of urinary calculi were evaluated by metaregression models. The stone risk index [defined as the ratio of calcium to magnesium-bicarbonate product in drinking water] was used to assess the risk of calculus formation. No correlation was found between the urinary calculus incidence and the amount of calcium, bicarbonate, or the total hardness of the drinking water. In contrast, water magnesium had a marginally significant nonlinear inverse relationship with the incidence of the disease in the capitals [R2 = 26%, P = .05 for a power model]. The stone risk index was associated nonlinearly with the calculus incidence [R2 = 28.4%, P = .04]. Urinary calculus incidence was inversely related with drinking water magnesium content. We introduced a new index constructed on the foundation of a pathophysiologically based formula; the stone risk index had a strong positive association with calculus incidence. This index can have therapeutic and preventive applications, yet to be confirmed by clinical trials

Familial relations and recurrence pattern in nephrolithiasis. New words about old subjects

While medical and surgical approaches to urolithiasis are different for single and recurrent stone former [RSF], the RSF definition itself is commonly overlooked. Moreover, despite consensus on association between family history [FH] and urolithiasis, more epidemiologic evidence is required to clarify the nature of this relationship. Our purpose was to propose a more precise definition of RSF, and also to investigate how family history may affect urolithiasis. Using a multistage stratified sampling in 4 seasonal phases, 6127 subjects with imaging-proven urolithiasis were detected in 12 Iranian regions. The FH of urolithiasis and the average interval between episodes [cycles] were determined by an informed interview. Of 6127 patients with the mean age of 41.8 +/- 15.1 years, 42% had FH, and 22.2% were RSF of whom 61% were men. The patients with FH had a greater chance of recurrence [OR = 1.2, 95% Confidence Interval [CI], 1.1 to 1.4]. Furthermore, patients with positive FH had more episodes [P = .0001], comparable cycles and younger ages at the onset [P = .02] than those patients without a FH. In the RSF group, the 90[th] percentiles of the cycle were 60 months and the estimated mean stone cycle for the population was 25.34 months [99% CI, 23.0 to 27.7]. Family history seems very common in Iranian population and is a risk factor for recurrence. Moreover, RSF could be identified by the estimated average cycle in the population [25.3 months] or by the percentiles

Palliative treatment of intractable hematuria in context of advanced bladder cancer a systematic review

In a patient with bladder urothelial cancer that is not suitable for or does not choose curative treatment, intractable hematuria is a disastrous condition. In this article, we tried to review the literature and extract a stepwise approach for palliative treatment of hematuria in these patients. The MEDLINE was searched with the help of the Medical Subject Headings system using different combinations of terms urinary bladder neoplasm, hematuria, carboprost, cyclophosphamide, cystitis, alum, and hyperbaric oxygenation. The articles were separately reviewed by the two authors and verified by each other. Eventually, a decision tree was developed for management of gross hematuria in patients with bladder cancer. Although, there was not any reported randomized controlled trial or prospectively designed study, the available case series were rather expressive to draw out a logical approach. Formalin has a grave adverse effect profile and is recommended only in special circumstances. For management of each case of gross hematuria in bladder cancer, the etiology of bleeding is the most important determinant. Hematuria in the context of advanced bladder neoplasms can now be effectively treated with fewer side effects using all available modalities in a logical holistic approach. We proposed a decision tree for management of hematuria in this context. However, regarding lack of well-designed trials, a treatment method should be based on individualized scenarios and clinical experience, bringing into account the patient's preferences

Ureteral calculi in children: What is best as a minimally invasive modality?

Minimally invasive treatment of ureteral calculi in children is a challenging topic. In an evidence-based review, we evaluated the efficacy and safety of extracorporeal shock wave lithotripsy [SWL] and ureteroscopic modalities for this group of patients. In this study, we performed a comprehensive systematic review on articles appeared in the PubMed from 1998 to March 2008. We selected all papers addressing SWL or ureteroscopic management of the ureteral calculi in children and determined the level of evidence of the presenting data. Thirty-nine articles were reviewed and 24 with valid information on SWL or ureteroscopic management of the pediatric ureteral calculi were analyzed. Six articles [25%] were randomized controlled trials and 18 [75%] were retrospective case-controls or case series. The following data were extracted from the 24 articles: in SWL groups, overall success rate was 84.1% [range, 71% to 100%] for the upper ureteral calculi and 76.2% [range, 19% to 91%] for the lower ureteral calculi. Only 61% of the patients had only 1 treatment course, while 8% and 31% of the cases required 2 and more than 2 sessions of treatment, respectively. With ureteroscopic management, the overall success rates were 93.2% [range, 81% to 100%] and 74.4% [range, 20% to 100%] in the lower and upper ureteral calculi, respectively. The main limitations of the series on minimally invasive treatment of pediatric ureteral calculi are lack of powerful randomized controlled trials or prospective data and insufficient patients numbers. Therefore, it is difficult to draw absolute conclusions about successful treatment based on current knowledge