Obesity has become a leading public health issue in the United States. The goal of this study was to examine whether patients experience a significant change in body mass index (BMI) or weight after total joint arthroplasty. Previous studies have not corrected for the natural, annual positive BMI change in North Americans aged 29 to 73 years. Our study takes this natural weight gain into consideration in examination of total hip arthroplasty (THA) and total knee arthroplasty (TKA) populations. Our study population trended toward weight loss and BMI loss when weight was corrected for natural gain. Clinically significant weight loss, as determined by US Food and Drug Administration parameters, occurred in 19.9% of the study population when weight was corrected for natural gain. The TKA population exhibited a statistically significant (P<.05) weight loss and a clinically significant weight loss in 21.5% of the population. Patients with an initial BMI >30 exhibited a trend toward weight loss. This study was a level II retrospective study.
Distal ureteral reconstruction for benign pathologies such as stricture disease or iatrogenic injury has posed a challenge for urologist as endoscopic procedures have poor long-term outcomes, requiring definitive open reconstruction. Over the past decade, there has been an increasing shift towards robot-assisted laparoscopy (RAL) with multiple institutions reporting their outcomes. In this article, we reviewed the current literature on RAL distal ureteral reconstruction, focusing on benign pathologies only. We present peri-operative data and outcomes on the most common technique, ureteral reimplantation, as well as adjunct procedures such as psoas hitch and Boari flap. Additionally, we present alternative techniques reported in the literature with some technical considerations. Lastly, we describe the outcomes of the comparative studies between open, laparoscopy, and RAL. Although the body of literature in this field is limited, RAL reconstruction of the distal ureter appears to be safe, feasible, and with some advantages over the traditional open approach.
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