Importance Kidney stone disease is common and may be associated with an increased risk of coronary heart disease (CHD). However, previous studies of the association between kidney stones and CHD have often not controlled for important risk factors, and the results have been inconsistent. Objective We examined the association between a history of kidney stones and the risk of CHD in three large prospective cohorts. Design, setting, and participants Prospective study of 45,748 men and 196,357 women in the United States without a history of CHD at baseline who were participants in the Health Professionals Follow-Up Study (HPFS, 51,529 men aged 40–75 years followed since 1986), Nurses’ Health Study (NHS) I (121,700 women aged 30–55 years followed since 1976) and II (116,430 women aged 25–42 years followed since 1989). The diagnoses of kidney stones and CHD were updated biennially during follow-up. Main outcome measure CHD was defined as fatal or non-fatal myocardial infarction (MI) or coronary revascularization. The outcome was identified by biennial questionnaires and confirmed through review of medical records (fatal and non-fatal MI). Results Out of a total of 242,105 participants, 19,678 reported a history of kidney stones. After up to 24 years of follow-up in men and 18 years in women, 16,838 incident cases of CHD occurred. After adjusting for potential confounders, among women, those with a reported history of kidney stones compared with those without had an increased risk of CHD in NHS I (incidence rate (IR) 754 vs 514/100,000 person-years; multivariate HR 1.18, 95% CI 1.08 to 1.28) and NHS II (IR 144 vs 55/100,000 person-years; multivariate HR 1.48, 95% CI 1.23 to 1.78); there was no significant association in men (IR 1,355 vs 1,022/100,000 person-years; multivariate HR 1.06, 95% CI 0.99 to 1.13). Similar results were found when analyzing the individual end-points (fatal and non-fatal MI, revascularization). Conclusions Among two cohorts of women, a history of kidney stones was associated with a modest but statistically significant increased risk of CHD; there was no significant association in a separate cohort of men. Further research is needed to determine whether the association is sex-specific.
Urolithiasis is a universal problem that has become increasingly prevalent in the United States and has a high rate of recurrence. Imaging of urolithiasis has evolved over the years due to technologic advances and a better understanding of the disease process. Computed tomography (CT) has been the investigation of choice for the evaluation of urinary stone disease. The emergence of multidetector CT and the recent introduction of dual-energy CT have further reinforced the superiority of this modality over other imaging techniques in the management of urolithiasis. Multidetector CT is not limited to simply helping make an accurate diagnosis in patients with stone disease; it is also useful in the assessment of stone burden, composition, and fragility, findings that are helpful in determining appropriate treatment strategies. In addition, multidetector CT is a valuable tool in the follow-up of patients after urologic intervention or institution of medical therapy. Familiarity with recent technologic developments will help radiologists meet the growing expectations of urologists in this setting. In addition, radiologists should be aware of the radiation risks inherent in the imaging of patients with urolithiasis and take appropriate measures to minimize this risk and optimize image quality.
extrinsic ureteric compression in nine cases (8.3%), benign extrinsic ureteric compression in two cases (1.9%), pelvic-ureteric junction obstruction in two cases (1.9%), vesicoureteric junction (VUJ) obstruction in one case (0.9%), bladder outlet obstruction in one case (0.9%) and iatrogenic causes in four cases (3.7%).• No definitive cause was found in nine cases (8.3%). For patients in whom a ureteric stone was the cause of forniceal rupture, the level of obstruction was proximal ureter in 24.3% of cases, distal ureter in 17.6% of cases and VUJ in 58.1% of cases.• Mean ( SD ) stone size was 4.09 (2.0) mm. Mean ( SD ) stone size was 5.34 (1.87) mm for proximal stones, 4.08 (1.69) mm for distal stones and 3.53 (1.96) mm for VUJ stones ( P = 0.005).• Urinary tract infection was present in five out of 97 patients (5.2%) in whom data were available for analysis. CONCLUSION• The most common aetiology of renal forniceal rupture is obstruction caused by distal ureteric stones followed by malignant extrinsic ureteric compression.
Since its introduction into the endourologist's armamentarium almost 40 years ago, percutaneous nephrolithotomy (PCNL) has become the standard of care for patients with large-volume nephrolithiasis. Postoperative infection is one of the most common complications of the procedure, and postoperative sepsis is one of the most detrimental. A number of factors have been found to increase the risk of postoperative sepsis. These include patient characteristics that are known preoperatively, such as urine culture obtained from the bladder or from the renal pelvis if percutaneous access to the renal pelvis is obtained in advance to the procedure. Neurogenic bladder dysfunction secondary to spinal cord injury and anatomical renal abnormalities, such as pelvicalyceal dilatation, have also been associated with increased incidence of fever and sepsis after the procedure. Several intraoperative factors, such as the average renal pressure sustained during PCNL and the operative time, also seem to increase the risk of sepsis. Finally, the contribution of postoperative factors, such as presence of a nephrostomy tube or a urethral catheter, has also been investigated. A short preoperative course of antibiotics has been found to significantly decrease the rate of postoperative fever and sepsis. Novel agents targeted at sepsis prevention and treatment, such as anti-endotoxin antibodies and cholesterol-lowering drugs statins, are currently under investigation.
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