Spencer Hart

Metabolic Syndrome and Urinary Stone Composition: What Factors Matter Most?

OBJECTIVE To determine which metabolic syndrome (MetS) factors lead to differences in stone composition in a multivariate analysis. METHODS We retrospectively reviewed medical charts of patients who had a kidney stone removed over a 5-year period (2006-2011). MetS factors (obesity [body mass index {BMI} >30], diabetes mellitus [DM], hypertension [HTN], and dyslipidemia [DLD]) were tallied in each patient. For the latter 3 factors, medical treatment for the condition was used to tag a patient with the condition. Stone composition was determined by the dominant (>50%) component. Statistical analysis was designed to determine which MetS factors were independently associated with differences in stone composition. RESULTS Five hundred ninety kidney stones were included in the analysis. Patients with MetS had a higher prevalence of uric acid stones and lower prevalence of calcium phosphate stones. HTN and DM were independently associated with differences in composition, specifically uric acid stones (higher proportion), and calcium phosphate stones (lower proportion). Obesity was not associated with differences in composition, although a secondary analysis of morbidly obese patients showed a higher proportion of uric acid stones and a lower proportion of calcium oxalate stones. CONCLUSION HTN and DM are the MetS factors independently associated with differences in stone composition, specifically the uric acid and calcium phosphate components. Obesity has little effect on stone composition until a very high (>40) BMI is reached. The overall effect of MetS factors on stone type is relatively small, because most stones are calcium oxalate and MetS factors have little impact on calcium oxalate frequency.

Comparison of complication rates for unilateral and bilateral percutaneous nephrolithotomy (PCNL) using a modified Clavien grading system

Whats known on the subject? and What does the study add?

Localized Perirenal Retroperitoneal Fibrosis

Perirenal retroperitoneal fibrosis (RPF) is a rare disease. RPF typically presents as a proliferation of fibrous tissue around the infrarenal aorta and the common iliac arteries. Rarely, RPF will only involve the perirenal space. We present the case of a 62-year-old man who was incidentally discovered to have isolated perirenal RPF.

Unusual videourodynamic finding: Massive scrotal cystocele

Urinary bladder involvement within inguinal hernias occurs in up to 4% of patients. However, massive extension of the bladder into the scrotum, or scrotal cystocele, is very rare, with less than 30 reported cases. The presenting symptoms vary. Most patients will have some element of voiding dysfunction. However, some patients will present with renal failure, sepsis, or bladder necrosis, although others will remain asymptomatic.(1-4) We report a patient who presented with irritative voiding symptoms and a large, right-sided hydrocele. On evaluation of his voiding symptoms, he was found to have a large scrotal cystocele.