The Role of Body Mass Index and Waist Circumference in Gender-Specific Risk Factors for Stress Urinary Incontinence: A Cross-Sectional Study.

Background Urinary incontinence is the loss of bladder control and is a common condition found more often in women. Incontinence can present in several ways. The various forms of incontinence include urgency urinary incontinence, stress urinary incontinence, and mixed urinary incontinence (a combination of both stress urinary incontinence and urgency urinary incontinence). Studies have been conflicting on the prevalence of UI in obese women compared to non-obese women. The subtypes of incontinence may play a role in the discrepancy currently found in research. In addition to the discrepancy seen between subtypes, there may be a reason to believe there is a difference in incontinence presentation and treatment across genders. Our research strives to understand the influences of gender, obesity, and waist circumference on different types of incontinence. Methodology Data were gathered from the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey dataset. Questionnaire data from March 2017 through March 2020 categorized as "Kidney Conditions - Urology" and "Weight History" were collected. Binary logistic regressions were performed to examine the association between variables associated with obesity including body mass index (BMI) and waist circumference and if the participant had a urine leak during physical activities. Covariates such as waist circumference, gender, age, race, educational level, and marital status were controlled for. Results We found that stress incontinence was positively associated with BMI, waist circumference, and age in men with regression coefficients of 0.038, 0.014, and 0.027, respectively, with a p-value <0.05. In women, stress incontinence was also associated with BMI, waist circumference, and age in addition to being white and being married. Linear regression coefficients were 0.036, 0.019, 0.015, -0.473, and -0.285, respectively, with p-values <0.05. Conclusions Our results suggest that BMI, waist circumference, and age are positively correlated with stress incontinence in both men and women. This is consistent with previous literature yet novel in evaluating stress incontinence in men. This would indicate that stress incontinence is similar among men and women which would indicate that weight loss is a therapeutic target for the treatment of stress incontinence in men. However, our findings additionally highlight the correlation between stress incontinence in women and race, a relationship not seen in men. This identifies a possible difference in the pathophysiology of stress incontinence across genders and would require further investigation into therapeutic treatments in men.

Association of Height and Prevalence of Kidney Stones.

Introduction and objectives Nephrolithiasis is universally understood to be a multifactorial disease resulting from genetic and environmental factors including gender, diet, calcium, and uric acid excretion. Notably, several of these factors may be related to body habitus. Because men are more likely to develop kidney stones and on average have a larger body size, height may be an important risk factor for stone formation. Several studies have demonstrated that short adult stature is associated with numerous conditions such as hypertension, hypercholesterolemia, and cardiovascular diseases. However, other studies have demonstrated otherwise. Additionally, stones have been shown to be correlated with a high body mass index (BMI). This is likely due to dietary factors. Although height is a component of BMI, there is minimal literature regarding the relationship of height to stone prevalence adjusting for weight.  Methods We aimed to examine whether short adult height is associated with the development of kidney stones using a population-based cohort of the National Center for Health Statistics. Data was gathered from National Health and Nutrition Examination Surveys (NHANES) "Kidney Conditions - Urology" and "Weight History" questionnaire datasets from March 2017 to March 2020 along with demographic data. Logistic regression analysis was used to determine an association between current self-reported height (inches) and if the participant has ever had kidney stones, controlling for weight, gender, age, race, educational level, and marital status.  Results We found that those who were shorter had higher odds of reporting a history of stones (OR: 1.017; 95%CI: 1.005-1.028). This association was found after controlling for covariates such as age, gender, race, education, and weight. In addition, the male gender and Hispanic race had higher odds of reporting a history of stones (OR: 1.43 and 1.073, respectively).  Conclusion Our results suggest that short height is related to the prevalence of kidney stones independent of weight, age, gender, and race. This supports previous literature indicating height to be a component of renal disease.

Segmental absence of intestinal musculature: an increasingly reported pathology.

BACKGROUND: Segmental absence of the intestinal musculature (SAIM) is a known but clinically rare entity involving partial or complete absence of the intestinal muscularis propria. Clinical presentation is consistent with peritonitis, and treatment involves an emergent laparotomy, bowel resection, and reanastamosis or possible ostomy creation. Diagnosis results from histopathologic evaluation of the resected intestinal specimen. Most of the publications are case reports. METHODS: We retrospectively reviewed all surgical pathology files at a tertiary pediatric hospital from 2003 to 2010, identifying children who were noted to have absence of intestinal musculature on pathology. Patients meeting criteria were reviewed in detail, and data regarding clinical presentation, diagnostic testing, radiologic findings, treatment, and outcome were recorded. RESULTS: Five patients were identified between 2003 and 2010 who received the diagnosis of SAIM. Patient age ranged from 1 to 99 days of life. All children were born preterm by cesarean section, had a mean birth weight of 828 ± 338 g, and were intubated after birth. CONCLUSIONS: The 5 patients presented are reviewed and contrasted with previous cases presented in the literature. Theories of pathogenesis and classification are discussed, and the cases are labeled as primary versus secondary SAIM.

Transperitoneal laparoscopic radical nephrectomy for patients with dialysis-dependent end-stage renal disease: an analysis and comparison of perioperative outcome.

OBJECTIVES: To evaluate LRN as treatment for high risk patients. Laparoscopic radical nephrectomy (LRN) is performed for renal tumors not amenable to nephron-sparing treatments. Indications are increasing to include higher risk patients including those with end-stage renal disease (ESRD) necessitating dialysis. METHODS: We performed a retrospective analysis of a patient cohort with clinical stage T1 renal tumors undergoing transperitoneal LRN. Parameters examined included patient demographics, medical comorbidities, tumor characteristics, operative outcomes, and complications. RESULTS: One hundred eighty-nine patients underwent 195 LRN. Sixteen patients (8.5%) had preexistent ESRD requiring dialysis. A higher American Society of Anesthiologists score (P<.05), higher age-adjusted Charlson comorbidity index (P=.003), higher incidence of previous abdominal surgery (P=.012), and higher incidence of hypertension (P=.025) were found for the ESRD group. Mean blood loss was 153.0 and 132.0 mL (P=.71) in the ESRD patients and non-ESRD patients, respectively. A longer stay (P=.02) was noted for ESRD patients. Mean tumor size in the ESRD patients and non-ESRD patients was 2.6 and 4.2 cm (P<.05), respectively. Renal cell carcinoma was the most common pathology in 14 of 20 (70.0%) ESRD patient renal units and 167 of 175 (95.4%) non-ESRD patient renal units (P=.001). Intraoperative and postoperative complication rates were 6.3% and 31.3% respectively for ESRD patients (P=.05), and 8.7% and 21.4% respectively for non-ESRD patients (P=.35). Most postoperative complications were minor. CONCLUSIONS: LRN, for the treatment of renal tumors in ESRD patients requiring dialysis, is feasible and safe with acceptable intraoperative and postoperative complication rates. Patients with ESRD may require longer hospital stay after LRN.

Percutaneous nephrolithotomy and cystolithalapaxy for a "forgotten" stent in a transplant kidney: case report and literature review.

Ureteral stents, when left in situ in renal transplant patients, are a potential iatrogenic cause of graft compromise and graft failure. Such patients may present with acute renal failure, recurrent urinary tract infections, hematuria, and dysuria. We present a case report of a renal transplant patient with a heavily encrusted forgotten stent. We employed a simultaneous approach, using percutaneous nephrostolithotomy and cystolithalapaxy, for complete removal of the encrusted stent and associated stones. A MEDLINE literature review was then performed to identify and analyze similar cases in which a forgotten stent in a renal allograft was removed. Our experience and that found in the medical literature suggest that removal of forgotten stents can be achieved safely and effectively with proper endourological techniques. We also reviewed the current status of ureteral stent design in terms of attempts to preclude this problem. Ureteral stent design is still in a state of evolution with a focus on creating stents of new materials, and stents with new coatings, that may prevent encrustation.

Impact of preoperative ureteral stenting on outcome of ureteroscopic treatment for urinary lithiasis.

PURPOSE: Sparse published data exist on the impact of preexistent ureteral stents on the success of ureteroscopic stone surgery. We investigated the impact of a preexistent ureteral stent in relation to a number of parameters and outcomes of ureteroscopic management for urinary lithiasis. MATERIALS AND METHODS: We retrospectively evaluated a cohort of patients undergoing ureteroscopy for renal and ureteral calculi. Data were abstracted on stone side, size, number and site, patient demographics, total stone burden, ureteral access sheath use, preoperative ureteral stent, ureteroscope type and outcome. Statistical analysis was done. RESULTS: The success rate of 1 and 2 ureteroscopic procedures was 86.9% and 97.3%, respectively. Primary analysis included data on 221 initial procedures. The single procedure success rate for stone site was 91.9% for the distal ureter, 89.7% for the proximal ureter, 83.3% for the renal pelvis, 80.5% for the lower pole and 82.4% for the interpolar/upper pole. Success was negatively associated with primary stone size (p = 0.020), total stone number (p = 0.001) and cumulative stone burden (p <0.001). Stone site was not a predictor of success (p = 0.394). A preexistent stent was positively associated with success but it was not statistically significant (adjusted OR 2.22; 95% CI 0.88, 5.63; p = 0.254). Secondary analysis in patients who initially underwent flexible ureteroscopy yielded results consistent with those of primary analysis. CONCLUSIONS: Results show that ureteropyeloscopic lithotripsy and stone extraction may be performed with a high success rate. Success was significantly inversely related to stone size, cumulative stone burden and number of stones. Success was positively related to a preexisting ureteral stent but not significantly so.

Laparoscopic radical nephrectomy for patients with T2 and T3 renal-cell carcinoma: evaluation of perioperative outcomes.

PURPOSE: Laparoscopic radical nephrectomy (LRN) is considered standard of care for T1 renal tumors not amenable to nephron-sparing surgery. Indications are now expanding to include patients with T2 or T3 tumors. The purpose of this study is to evaluate LRN as a minimally invasive procedure for treatment of advanced stage renal tumors. MATERIALS AND METHODS: We performed a retrospective analysis of a cohort of consecutive patients with renal tumors undergoing LRN for clinical stages T1 to T3. Parameters examined included patient demographics, medical comorbidities, tumor characteristics, perioperative outcomes, and complications. RESULTS: In all, 252 kidneys were removed from 247 consecutive patients undergoing LRN; 246/252 (97.6%) kidneys contained renal-cell carcinoma and 55 (21.8%) patients had pT2/T3 disease. Mean pathologic tumor size in the T1 and T2/T3 groups was 4.1 and 7.8 cm, respectively. Compared with patients with T1 tumor, patients with T2/T3 tumor had higher body mass index (p = 0.010), higher specimen weight (p = 0.002), higher mean Fuhrman grade (p = 0.014), and more postoperative complications (p = 0.035). Mean blood loss for T1 and T2/T3 patients was 133 and 198 cc, respectively; 3/197 patients (1.5%) and 4/55 patients (7.3%) in the T1 and T2/T3 groups received blood transfusion, respectively (p < or = 0.05). CONCLUSIONS: LRN for the treatment of clinical stage T2 and T3 disease should be considered. LRN can be safely performed with good perioperative outcome. Blood transfusion and complication rates are higher for LRN in pT2/T3 patients. However, the decision to modify surgical technique should be considered when either oncologic efficacy or patient safety is a concern.

Comparison of different extraction sites used during laparoscopic radical nephrectomy.

PURPOSE: Laparoscopic radical nephrectomy is commonly performed for renal tumors that are not amenable to nephron sparing treatment. A number of techniques for intact specimen extraction are used. The development of incisional hernias from the extraction site is a known but infrequent delayed complication. We analyzed different extraction sites and risk factors for such hernias. MATERIALS AND METHODS: We retrospectively analyzed a cohort of patients undergoing laparoscopic radical nephrectomy with intact specimen extraction through 3 sites. Patients and operation specific parameters were included with particular attention to factors predisposing patients to incisional hernia, including chronic obstructive pulmonary disease, diabetes mellitus, chronic steroid use and a high body mass index. RESULTS: A total of 181 nephrectomies were performed in 175 patients and 175 kidneys (96.7%) had malignancy. Mean tumor size was 4.9 cm. Mean followup was 28.8 months. Extraction was done from a lower quadrant site in 55 patients (31.4%), from the umbilical site in 58 (33.2%) and from a paramedian site in 62 (35.4%). Patients with paramedian and lower quadrant extraction sites were older (p = 0.016), and had a higher body mass index (p = 0.001) and greater specimen weight (p = 0.003). In 4 patients an incisional hernia developed. An incisional hernia was significantly associated with the paramedian extraction site (p = 0.015). CONCLUSIONS: Incisional hernias may occur as a delayed complication of laparoscopic radical nephrectomy. This complication most commonly develops at the extraction site. In patients with a high body mass index using a paramedian extraction site is a significant risk factor for incisional hernia formation.

Construction-related differences seen in ureteral access sheaths: comparison of reinforced versus nonreinforced ureteral access sheaths.

OBJECTIVES: Ureteral access sheaths (UASs) are used to facilitate ureteroscopic procedures. Difficulties with use have been reported. Manufacturers have redesigned these devices to ameliorate these problems, including reinforcement of the sheath wall. This study compared reinforced (RUASs) and nonreinforced UASs (NRUASs) of the same manufacturer to determine whether RUASs expedite ureteroscopy and how relevant the reinforced structure is in terms of overall success. METHODS: We prospectively followed up patients undergoing ureteroscopy for urolithiasis with 1 of 2 UASs; the Applied NRUAS and the Applied RUAS. The demographics, operative parameters, and outcomes were assessed. Statistical analysis was performed. RESULTS: A total of 98 UASs were used in 68 male and 30 female patients (47 NRUASs and 51 RUASs). No significant differences were found between the groups in terms of demographic parameters, operative parameters, or successful sheath deployment. The overall success rate for sheath deployment was 95%. A pre-existing stent was significantly associated with successful deployment (P = .004). The sheath-specific limitations included kinking (NRUASs, 10%) and sheath angulation/deformity (RUASs, 21%). The mean follow-up time was 43.4 months; and 93.9% of the patients had radiologic follow-up. No ureteral strictures were noted. CONCLUSIONS: No significant difference was found in the overall success rates between the use of Applied NRUASs and RUASs. The presence of a pre-existing stent was significantly associated with successful sheath deployment. Each UAS design had its own unique limitations, seen with low frequency. Successful sheath use might relate to both the sheath itself and the patient/operative parameters.