Background The prevalence of kidney stone disease is rising along with increasing rates of obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome. Objective To investigate the associations among the presence and severity of T2DM, glycemic control and insulin resistance with kidney stone disease. Design, Setting, and Participants We performed a cross-sectional analysis of all adult participants in the 2007–2010 National Health and Nutrition Examination Survey (NHANES). A history of kidney stone disease was obtained by self-report. T2DM was defined by: self-reported history, T2DM-related medication usage, and reported diabetic comorbidity. Insulin resistance was estimated using fasting plasma insulin (FPI) levels and the homeostasis model assessment of insulin resistance (HOMA-IR) definition. We classified glycemic control using HbA1c and fasting plasma glucose levels (FPG). Outcome measurements and statistical analysis Odds ratios (OR) for kidney stone disease were calculated for each individual measure of T2DM severity. Logistic regression models were fitted adjusting for age, sex, race/ethnicity, smoking history, and Quételet’s (body mass) index (BMI) (model A) as well as laboratory values and components of metabolic syndrome (model B). Results and Limitations Correlates of kidney stone disease included a self-reported history of T2DM (OR 2.44, 95% confidence interval [CI] 1.84–3.25) and history of insulin use (OR 3.31, CI 2.02-5.45). Persons with FPG 100–126 and >126 mg/dL had increased odds of kidney stone disease, OR 1.28 (CI 0.95–1.72) and OR 2.29 (CI 1.68-3.12), respectively. Corresponding results for persons with HgbA1c 5.7-6.4% and ≥6.5% were ORs 1.68 (CI 1.17–2.42) and OR 2.82 (CI 1.98–4.02), respectively. When adjusting for patient factors, a history of T2DM, the use of insulin, FPI and HgbA1c remained significantly associated with kidney stone disease. The cross-sectional design limits causal inference. Conclusions Among persons with T2DM, more severe disease is associated with a heightened risk of kidney stones.

Purpose To systematically review the evidence for the efficacy and safety of botulinum toxin in the management of OAB. Materials and Methods We performed a systematic review of the literature to identify articles published between 1985 and March 2009 on intravesical botulinum toxin A (BTX) injections for the treatment of refractory idiopathic overactive bladder in both men and women. Database searched included MEDLINE, CENTRAL, and EMBASE. Data were tabulated from case series and from randomized controlled trials (RCTs). Data were pooled where appropriate. Results Our literature search identified 432 titles. Twenty-three full articles were included in the final review. Three randomized placebo-controlled trials addressing the use of botulinum toxin-A were identified (99 patients total). The pooled random effects estimate of effect across all three studies was 3.88 (95% C.I. -6.15, -1.62), meaning that patients treated with BTX had 3.88 fewer incontinence episodes per day. UDI data revealed significant improvements in quality of life compared with placebo, with a standardized mean difference of -0.62 (CI -1.04, -0.21). Data from case series demonstrated significant improvements in OAB symptoms and quality of life, despite heterogeneity in methodology and case mix. However, based on the randomized controlled trials, there was a nine-fold increased risk of elevated post-void residual after BTX compared with placebo (8.55, 95% CI 3.22-22.71). Conclusions Intravesical injection of botulinum toxin resulted in improvement in medication-refractory OAB symptoms. However, the risk of elevated post-void residual and symptomatic urinary retention was significant. Several questions remain concerning the optimal administration of BTX for the OAB patient.

Introduction Erectile dysfunction (ED) is more common in men with type 2 diabetes mellitus (T2DM), obesity, and/or the metabolic syndrome (MetS). Aim To investigate the associations among proxy measures of diabetic severity and the presence of metabolic syndrome (MetS) with erectile dysfunction (ED) in a nationally representative U.S. data sample. Methods We performed a cross-sectional analysis of adult participants in the 2001–2004 National Health and Nutrition Examination Survey (NHANES). Main outcome measures ED was ascertained by self-report. T2DM severity was defined by calculated measures of glycemic control and insulin resistance (IR). Insulin resistance was estimated using fasting plasma insulin (FPI) levels and the homeostasis model assessment of insulin resistance (HOMA-IR) definition. We classified glycemic control using HbA1c and fasting plasma glucose levels (FPG). Metabolic syndrome was defined by the American Heart Association and National Heart, Lung, and Blood Institute criteria. Logistic regression models, adjusted for sociodemographics, risk factors and comorbidities, were fitted for each measure of T2DM severity, MetS, and the presence of ED. Results Proxy measures of glycemic control and insulin resistance were associated with ED. Participants with FPG between 100–126mg/dL (5.6–7 mmol/L) and ≥126mg/dL (>7mmol/L) had higher odds of ED, OR 1.22 [CI, 0.83–1.80] and OR 2.68 [CI, 1.48–4.86], respectively. Participants with HbA1c 5.7–6.4% (38.8–46.4 mmol/mol) and ≥6.5% (47.5 mmol/mol) had higher odds of ED, (OR 1.73 [CI, 1.08–2.76] and 3.70 [CI, 2.19–6.27], respectively). When FPI and HOMA-IR were evaluated by tertiles, there was a graded relation among participants in the top tertile. In multivariable models, a strong association remained between HbA1c and ED (OR 3.19 [CI,1.13–9.01]). MetS was associated with >2.5-fold increased odds of self reported ED (OR 2.55 [CI, 1.85–3.52]). Conclusions Poor glycemic control, impaired insulin sensitivity and the MetS are associated with a heightened risk of ED.

Objectives To identify patterns in the surgical management of women with stress urinary incontinence in the United States from 1992 to 2001. Methods As part of the Urologic Diseases in America Project, we analyzed data from a 5% national random sample of female Medicare beneficiaries age 65 and older. Data were obtained from the Centers for Medicare and Medicaid Services carrier and outpatient files from 1992, 1995, 1998, and 2001. Women in the sample with a diagnosis of urinary incontinence were identified by ICD-9 codes. Surgical procedures were identified by CPT-4 codes. Patterns of care were then analyzed over the 10-year period. Results The overall number of surgical procedures increased from 18,820 to 32,480 over the 10-year period, likely due to the growing population of Medicare beneficiaries. The needle suspension was the most commonly performed incontinence procedure in 1992 and 1995, while collagen injection gained rapid popularity and became the most common procedure in 1998. A drastic increase in the numbers and rates of slings occurred between 1995 and 2001. Conclusions The 1990s saw a rapid shift in the surgical management of stress urinary incontinence. The rapid increase in utilization of sling procedures corresponded with a decrease in utilization of the many other available anti-incontinence procedures. As in years prior, we identified a trend toward minimally invasive approaches to surgery, without the presence of randomized controlled clinical trials to support these trends. We anticipate that analysis of Medicare claims from 2004 and onward will demonstrate a further increase in the use of sling procedures.

Despite an increased prevalence of stress and urge urinary incontinence among women with diabetes, measures of diabetes mellitus type II are not independently associated with female incontinence. Rather, body mass index and several other characteristics are the dominant risk factors for stress or urge urinary incontinence.