Do Lifestyle Factors Including Smoking, Alcohol, and Exercise Impact Your Risk of Developing Kidney Stone Disease? Outcomes of a Systematic Review.

Introduction: With a rise in the incidence of stone disease, more research is needed to understand the lifestyle factors associated with it. We evaluate available evidence for association of smoking, alcohol, and exercise with kidney stone disease (KSD). Methods: A systematic literature search was conducted in CINAHL, EMBASE, Ovid Medline, Cochrane Library, Scopus, Clinicaltrials.gov, and Google Scholar. Different keywords were "smoking," "cigarette," "alcohol," "spirits," "exercise," "physical activity," "training," "kidney stone," "stone disease," "nephrolithiasis," "urolithiasis," "renal stone," and "urinary stone." The main outcome of interest was the role of smoking, alcohol, and exercise in the development of KSD. Results: A total of 4921 articles were found on searching the databases, of which 14 met the criteria for inclusion in the final review. Studies assessed the following risk factors, physical activity (n = 6), alcohol (n = 6), and smoking (n = 9), and included 17,511 patients. The relationship of physical activity with KSD appears to be equivocal. In addition, only one study demonstrated a decreased risk of nephrolithiasis with alcohol consumption. On the contrary, four studies found a significant association between smoking and renal stone formation. Conclusions: While smoking is one behavioral factor that seems to have some association with KSD, no clear effect of alcohol and physical activity has been demonstrated. To avoid KSD, awareness of the possible detrimental role of smoking should be considered and patients should remain vigilant about the importance of hydration with physical activity. While this represents the most appropriate guidance from the evidence available, at present there remain insufficient data to truly reveal the relationship between these three factors and KSD.

Role of endoscopic management in synthetic sling/mesh erosion following previous incontinence surgery: a systematic review from European Association of Urologists Young Academic Urologists (YAU) and Uro-technology (ESUT) groups.

INTRODUCTION AND HYPOTHESIS: Foreign body (FB) erosion is now recognized as a major long-term complication following previous incontinence surgery. The aim of our systematic review was to ascertain the outcomes of endoscopic management in synthetic sling/mesh erosion following previous gynaecological surgery. METHODS: A systematic review in line with PRISMA and Cochrane guidelines was conducted for all English language articles between 1996 and December 2018 for all articles reporting on endoscopic surgical management for eroded FB following previous sling/mesh procedure for incontinence. RESULTS: Our search produced 931 articles of which 20 articles (198 patients) were included in our review; 149 (75%) had tension-free vaginal tapes (TVT) or tension-free obturator tapes (TOT) as their initial procedure. The site of mesh erosion was the bladder in 134 patients (68%) of which 12 (6%) were in the bladder neck. Urethral mesh erosion was seen in 63 patients (32%) across all studies. The treatment of eroded mesh was by laser and endoscopic excision using an electrode loop or laparoscopic scissors in 108 (55%) and 90 (45%) patients respectively. The initial/final success rate with laser and endoscopic excision was 67%/92% and 80%/98% respectively. The overall complication rates were 24% and 28% in laser and endoscopic groups respectively of which 21% in each group were stress urinary incontinence. CONCLUSIONS: Endoscopic management of FB erosion is an effective minimally invasive technique with good outcomes and minimal morbidity. Management with the use of holmium laser is gaining momentum and could be attempted before open surgical removal. There is a need for comparative data between open surgical excision and endoscopic excision to help better describe the patient's most likely to benefit from the endoscopic technique.

Role of pelvicalyceal anatomy in the outcomes of retrograde intrarenal surgery (RIRS) for lower pole stones: outcomes with a systematic review of literature.

Controversies exist on the influence of lower pole anatomy (infundibular pelvic angle, IPA; infundibular length, IL; and infundibular width, IW) for success and outcomes related to the treatment of stones in the lower pole. We wanted to look at the role of lower pole anatomy to study clinical outcomes in patients treated for isolated lower pole stones (LPS) using retrograde intra renal surgery (RIRS), and also perform a review to look at the published literature on the influence of pelvicalyceal anatomy on success with RIRS. Data were prospectively collected (June 2013-June 2016) for all patients who underwent RIRS for LPS, and the imaging was then retrospectively reviewed to calculate the IPA, IL and IW using the Elbahnasy method. A systematic review was also conducted for all English language articles between January 2000 and April 2018, reporting on the impact of pelvicaliceal anatomy on RIRS. A total of 108 patients with LPS were included with a male to female ratio of 2:3 and a mean age of 54.7 years. The mean lower pole stone size was 9.3 mm (range 3-29 mm) and 102/108 (94.4%) patients were stone free (SF) at the end of their procedure. While steep IPA (< 30°), operative time duration and larger stone size were significant predictors of failure, the placement of ureteric access sheath, IW and IL did not influence treatment outcomes. Six studies (460 patients) met the inclusion criteria for our review. The IPA, IW, IL for failure ranged from 26° to 38°, 5.5-7 mm and 24-34 mm, respectively. The SFR ranged from 78 to 88% with a metaanalysis showing IPA as the most important predictor of treatment outcomes for LPS. Infundibular pelvic angle seems to be the most important predictor for the treatment of LPS using RIRS. Pelvicalyceal anatomy in conjunction with stone size and hardness seem to dictate the success, and decisions on the type of surgical interventions should reflect this.