Association between multiple chronic conditions and urolithiasis.

PURPOSE: Given the risk factors for stone disease, it is possible that multiple chronic condition (MCC) patients are at increased risk of developing new, recurrent, or worsening urolithiasis. The purpose of our investigation was to evaluate the relationship between MCCs and urolithiasis. METHODS: Retrospective cohort using outpatient claims data for all adult members (≥18 years) of the Beaumont Employee Health Plan who received outpatient care between 2008 and 2013. Multiple logistic regression adjusted for age, sex, obesity, hyperlipidemia, hypertension, and diabetes was used to assess the relationship between number of comorbid chronic conditions and urolithiasis. RESULTS: The cohort consisted of 34,173 adult patients with an average age of 40.4 years and 61.2% being female. The prevalence of urolithiasis was 3.1% (n = 1059). Patients with urolithiasis had a significantly higher average number of comorbid chronic conditions (2.4 vs. 1.3, p < 0.001) than patient without urolithiasis. Both crude (OR 1.34; 95% CI 1.30-1.38) and adjusted logistic regression models (OR 1.37; 95% CI 1.31-1.44) revealed a significant relationship between number of comorbid chronic conditions and urolithiasis. More than 81% of patients had one or more co-occurring chronic conditions; the most common MCC combinations associated with urolithiasis were hypertension-hyperlipidemia, chronic back pain, and hyperlipidemia. CONCLUSION: We report an association between MCCs and urolithiasis. Future research is needed to better understand the temporality and strength of this relationship. Physicians should recognize that urolithiasis and MCCs are closely related and therefore may consider more aggressive primary prevention of chronic disease and improved management of MCCs.

Robot-Assisted Laparoscopic Nephroureterectomy for Transitional Cell Carcinoma of a Right Pelvic Kidney.

BACKGROUND: Nephroureterectomy is the standard of care for transitional cell carcinoma (TCC) involving the upper urinary tract. However, few published case reports exist describing the surgical treatment of ectopic kidneys with TCC. Surgical removal of a pelvic kidney can be complicated by aberrant vasculature supply, a tortuous ureter and abutting anatomical structures. Thus, it is necessary to determine the most appropriate surgical technique for treatment of pelvic kidneys with suspected malignancy. CASE PRESENTATION: A 65-year-old female who presented with hematuria and lower abdominal pain was found to have a right pelvic kidney with a heterogeneous mass on computed tomography (CT) urogram. A robot-assisted laparoscopic nephroureterectomy of the right pelvic kidney was performed. Histopathological analysis revealed high-grade TCC with microscopic extension through the muscularis propria of the renal pelvis and superficially into the renal parenchyma. CONCLUSION: This case demonstrates the successful use of robot-assisted laparoscopic nephroureterectomy in the treatment of a pelvic kidney with TCC. Preoperative CT angiography is critical to define vascular anatomy and to prevent significant blood loss and damage to surrounding structures during surgery. This case was presented because TCC of a pelvic kidney is a rare occurrence and the use of robot-assisted nephroureterectomy for treatment of this disease is novel.