Stone prevention? Water, Water, Water!

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Some people will buy a 24 pack of bottled water and keep in a cool place in their car and drink a bottle every time they get in or out of their car. Ideas like this are helpful in making sure you are well hydrated. JM

Only Half of First-Time Stone Formers Achieve Stone Prevention Targets for Fluid Intake, UV

Urology – December 30, 2017 – Vol. 36 – No. 2

Approximately 50% of first-time stone formers achieve compliance targets for fluid intake and urine volume (UV). Factors decreasing compliance include initial UV <1 L, older age, female gender, and the presence of lower urinary tract symptoms.

Article Reviewed: Factors Associated With Compliance to Increased Fluid Intake and Urine Volume Following Dietary Counseling in First-Time Kidney Stone Patients. Khambati A, Matulewicz RS, et al: J Endourol; 2017;31 (June): 605-610.

Background: Fluid intake is critical for kidney stone prevention. Not all patients are compliant with this recommendation despite its effectiveness.

Objective: To evaluate compliance with fluid intake and urine volume (UV) recommendations in patients with nephrolithiasis and assess factors influencing compliance.

Design: Retrospective study.

Methods: Between 2010 and 2015, first-time kidney stone patients with UV <2.5 L/d on initial 24 hour urine were reviewed. Patients received instruction on strategies to increase fluid intake and target goals of >3 L/d fluid intake and >2.5 L/d UV. Repeat 24 hour urine collections were obtained at 6 and 18 months. Demographic and clinical data were analyzed to determine factors associated with compliance.

Results: 363 patients were included in the study. Mean baseline UV was 1.63 L/d, which increased to 2.5 L/d at 6 months. The compliance rate for UV >2.5 L/d at 6 months was only 50.1%, and decreased to 47.5% at 18 months. Overall, 30 patients (8.3%) had UV <1L/d, and only 20% of these patients reached the target 2.5 L/d at 6 months compared to 50.2% of patients with baseline UV of 1 to 2 L/d, and 61.8% of patients with baseline UV of 2 to 2.5 L/d (P =0.001). Factors associated with increased compliance included male gender (odds ratio [OR], 3.27), surgical procedures for stones (OR 2.3 to 3.5), and baseline UV >1L/d (OR, 3.0). Lower compliance was seen for patients aged >58 years and those with lower urinary tract symptoms (LUTS) (OR, 0.39 and 0.50).

Conclusions: Approximately 50% of first-time stone formers achieve compliance targets for fluid intake and urine volume. Factors decreasing compliance include initial UV <1 L/d, older age, female gender, and the presence of LUTS.

Reviewer’s Comments: When I ask my recurrent stone formers what advice they have been given for stone prevention, I often hear “my doctor only told me to increase fluids.” It occurs to me that patients do not understand the importance of increasing fluid intake and in turn urine volume. Of all the strategies we preach for stone prevention, fluid intake is one of the few that have randomized controlled trial data to support it. It is important to explain that UV is even more important than intake as insensible losses differ from patient to patient; therefore, UV will also differ between patients with the same fluid intake.

The current study assists in understanding which patients are likely to need additional instruction to achieve compliance.In the technology age, there are aides to help patients including apps for mobile devices and attachments for water bottles that flash to remind a patient to drink.

This study also illustrates how as urologists we need to assess and treat patients with LUTS, which can greatly influence compliance with fluid recommendations particularly given the significant impact LUTS have on quality of life.(Reviewer–Nicole L. Miller, MD).

 

Author: Khambati A, Matulewicz RS, et al
Author Email: aziz.khambati@medportal.ca

How common is it for the male to want to reverse a vasectomy?

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Predictive factors for vasectomy include income, number of biologic children, access to care, education level, religion, and race.

Article Reviewed: Vasectomy Demographics and Postvasectomy Desire for Future Children: Results From a Contemporary National Survey. Sharma V, Le BV, et al: Fertil Steril; 2013;99 (June): 1880-1885.

Background: Nearly half a million men choose vasectomy each year. Having a clear understanding of which men undergo a vasectomy can help improve counseling and possibly provide guidance to increase acceptance in those not currently seeking vasectomy. Additionally, because the rate of desire for subsequent fertility is often calculated from men presenting for vasectomy reversal consultations, this may underestimate the numbers.

Objective: To determine the demographic factors of men choosing vasectomy and to define the number of men subsequently desiring fertility post-vasectomy.

Design: Analysis of National Survey of Family Growth (NSFG).

Methods: The NSFG was conducted from June 2006 to June 2010 and sampled 10,403 men aged 15 to 45 years. Participants were questioned by female interviewers and compensated $40. Using Centers for Disease Control and Prevention methodology, the 110 diverse sampling units were adjusted based on census data to estimate national results.

Results: 8992 men aged ≥18 years were surveyed and 368 had a vasectomy during this time frame. This corresponds to a prevalence of 6.6%, markedly lower than the tubal ligation prevalence of 16.4% in women for the same age ranges. White men were more likely to have undergone vasectomy, with a prevalence of 9.1%. Black men and Hispanics had a prevalence of 2.4% and 2.1%, respectively. Other factors increasing the prevalence of vasectomy included income, education level, access to health care, and U.S. born (compared to immigrants). In total, 84% of the men had at least 2 children and 21% of men who were adoptive fathers had a vasectomy. The overall strongest predictor was number of biologic children. Overall, 19% of men who had undergone vasectomy desired future children and this was more likely when men belonged to a religion. Only 2% of men had undergone a vasectomy reversal.

Conclusions: Predictive factors for vasectomy include number of biologic children, race, and access to care. Nearly 1 in 5 of these men desired subsequent fertility.

Reviewer’s Comments: These data match my general perception of the typical male presenting to my office for vasectomy consultation. It is interesting to see that black men and Hispanic men do not pursue vasectomy as often and this may be an area for growth if cultural concerns can be addressed. Most interesting in this manuscript is the fact that 1 in 5 men desire subsequent fertility. I am curious if some of the men described as adoptive fathers were in this group. I believe counseling on the option of vasectomy reversal or in vitro fertilization is important during the vasectomy visit so men realize there are options, but the cost of these procedures should also be discussed. It would also be interesting to see if the same demographics are seen in countries with universal health care and limited access issues.(Reviewer–Gregory Lowe, MD).