RESUMEN
BACKGROUND AND OBJECTIVES: Bone demineralization is frequent in renal-stone formers with hypercalciuria. Although this pathologic link has been recognized for decades, the underlying mechanisms and risk factors associated with osteopenia/osteoporosis in this population remain partially understood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study retrospectively analyzed determinants of low bone mineral density (BMD) in 65 idiopathic hypercalciuric male renal-stone formers. Clinical and biologic evaluation included BMD measurement, bone-remodeling markers, analysis of calcium metabolism with oral calcium load test, and dietary inquiry. RESULTS: Patients with osteopenia (n=23, 35% of the population) presented significantly higher fasting calciuria as compared with normal bone density patients (n=42) (calcium/creatinine ratio was 0.32 versus 0.24 mmol/mmol; P=0.006). Analysis of the whole population revealed a negative association between fasting hypercalciuria and BMD (P = 0.003), independent of confounding variables including body-mass index and tobacco consumption. The fasting calcium/creatinine ratio above 0.25 mmol/mmol was associated with a 3.8-fold increase in the risk of low BMD. CONCLUSION: In our study, fasting hypercalciuria after a 2-day calcium-restricted diet appears as the only biologic factor associated with low BMD, suggesting a bone-calcium efflux. Our results support the view of a parathyroid-independent pathologic process that remains to be identified. Hypercalciuric patients with low BMD do not excrete more calcium in 24-hour urine samples than patients without low BMD.
Asunto(s)
Enfermedades Óseas Metabólicas , Hipercalciuria , Cálculos Renales , Osteoporosis , Adulto , Enfermedades Óseas Metabólicas/diagnóstico , Enfermedades Óseas Metabólicas/epidemiología , Enfermedades Óseas Metabólicas/metabolismo , Calcificación Fisiológica , Calcio/sangre , Calcio/orina , Calcio de la Dieta/administración & dosificación , Calcio de la Dieta/farmacocinética , Humanos , Hipercalciuria/diagnóstico , Hipercalciuria/epidemiología , Hipercalciuria/metabolismo , Cálculos Renales/diagnóstico , Cálculos Renales/epidemiología , Cálculos Renales/metabolismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Osteoporosis/diagnóstico , Osteoporosis/epidemiología , Osteoporosis/metabolismo , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Transobturator male slings have been proposed to manage stress urinary incontinence (SUI) after prostatic surgery, but data are still lacking. OBJECTIVE: To determine the safety and prospectively evaluate the clinical outcome after management of SUI after prostatic surgery by placement of a transobturator male sling. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective evaluation on 102 patients treated in a single center between 2007 and 2009 for mild to moderate SUI following prostatic surgery. INTERVENTIONS: Placement of a suburethral transobturator sling and clinical follow-up. MEASUREMENTS: Patients were evaluated by medical history, preoperative urodynamics, maximum flow rate measurement, 24-h pad test, and daily pad use. During follow-up, data on patients' pad use, complications, and answers to the Patient Global Impression of Improvement (PGI-I) questionnaire were collected. Cure was defined as no pad usage or one pad for security reasons and improvement as reduction of pads≥50%. Median follow-up was 13 mo (range: 6-26). RESULTS AND LIMITATIONS: Most patients (95%) presented post-radical prostatectomy incontinence (PRPI). Hospital stay was 2 d in 97 cases, and all patients were catheterized for 24h except two (48 h). Of 102 patients, 64 were cured, 18 were improved, and 20 were not improved. According to the PGI-I questionnaire, 85%, 11%, and 4% of patients described a respectively better, unchanged, and worse urinary tract condition, respectively. Previous radiation was associated with higher rate of failure (p=0.039). Neither severe complication nor postoperative urinary obstruction was noted during follow-up. CONCLUSIONS: Placement of a transobturator sling is a safe and effective procedure, giving durable results after >1 yr of follow-up. Further evaluation and high-quality controlled, randomized studies are needed to assess long-term efficacy and precise indications of this procedure for post-prostatic-surgery SUI management.
Asunto(s)
Complicaciones Posoperatorias/cirugía , Prostatectomía/efectos adversos , Neoplasias de la Próstata/cirugía , Cabestrillo Suburetral , Incontinencia Urinaria de Esfuerzo/cirugía , Anciano , Anciano de 80 o más Años , Estudios de Seguimiento , Humanos , Pañales para la Incontinencia , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Cabestrillo Suburetral/efectos adversos , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the prevalence, prognosis and possible risk factors of renal cell carcinoma (RCC) of the native kidney in renal transplant recipients. PATIENTS AND METHODS: We retrospectively re-examined the follow-up data of 373 consecutive renal transplant recipients at our institution between August 1993 and September 2004. We collected the data of all de novo RCC of the native kidney in the current analysis. RESULTS: Of the 373 patients examined, 12 tumours of the native kidney were diagnosed in 10 individuals. The mean ages at transplantation and diagnosis were 33 and 45.8 years, respectively. Thirteen malignancies were discovered fortuitously. Among the renal ultrasonograms there were two false-negative results. The mean tumour size was 21 mm. Nephrectomy was performed in all cases. Among the 12 kidney malignancies, there were five conventional RCCs and seven papillary RCCs. Half of all tumours were Furhman Grade 3 lesions, and pT1aN0M0 tumours also accounted for all malignancies in the current cohort. One of the 10 patients died, from progression of metastases 6 years after diagnosis. One patient had a local recurrence 2 years after diagnosis. The other eight patients were alive with no evidence of disease at the time of the current report. No significant relationship was detected between RCC occurrence and clinical patient characteristics. CONCLUSIONS: There appears to be a greater risk of RCC of the native kidney in patients with end-stage renal disease. The present results suggest that an annual examination of the native kidney before and after renal transplantation is essential.