Stone prevention? Water, Water, Water!

004

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

Do you have a vasectomy or vasectomy reversal question for the doctor?

Vasectomy.com- Ask a Doctor

Click the Ask a Doctor link above and you’ll be prompted to a question page at vasectomy.com. Your question is then given to urologists across America to answer…including Dr. McHugh. When it is answered it will be sent to your email and shared for all to benefit from the responses. Try it!

Question: Persistent sperm after a vasectomy?

Persistent sperm after vasectomy? A relatively common issue that is frustrating to the patient and the urologist alike.

Vas Pro Shop-"We Cater to Cowards"

From Vasectomy.com

My husband had a vasectomy 8 months ago he has had more then 40 ejaculation since his surgery, or maybe even more. The semen analysis came back with more then 20 hpf. Motile and non motile sperm were seen. Could his vasectomy have failed, or can it take a long time to become sterile? Thank you.

Dr. McHugh’s answer:

There two scenarios here. It is possible that the vasectomy has successfully divided the vas and that the sperm are, for whatever reason, slow to completely clear. If this is the thinking you would re check after another twenty or so ejaculations. On the other hand this may represent a recanalization of the vas tubes, a small channel, that has reconnected the vas tubes. In this case another vasectomy would be performed. A couple of things: You could have a formal semen analysis performed to actually get a count…

View original post 65 more words

Why do Vasectomy Reversals cost more than vasectomies?

Patients commonly ask if a microscopic vasectomy reversal is similar to having a vasectomy. The former takes two hours or so to perform and the latter fifteen minutes. This explains why a patient might experience more bruising and swelling with a reversal.

Georgia Vasectomy Reversal-John McHugh M.D.

th

Cutting the vas deferens in two (a vasectomy) is easier than putting it back together (a vasectomy reversal) and is indeed a horse of a different color.

  • Vasectomies are covered by insurance-vas reversals are not.
  • Because the reversal is not covered by insurance the patient sees, feels, and pays the entire expense of the procedure, the surgeon, the supplies (microscopic suture) and the facility.
  • The surgeon fees are relatively high because very few urologists do reversals often or often enough to do well.
  • Few urologists are comfortable enough to feel they can do the procedure with a high likelihood of patency (presence of sperm after a vasectomy reversal) and this in turn also limits the number of urologists willing to perform the procedure.
  • The identification of the vasectomy site and preparing it for the reversal is something that is comfortable to all urologists. Reanastamosing the inner tubule of the vas…

View original post 584 more words

Solutions for Female Stress Urinary Incontinence

The treatment of incontinence is a multi-factorial pursuit. In addition to the treatments listed estrogen cream and attention to food triggers should be considered. J.M.

St. Louis Missouri Urologists

Metropolitan Urological Specialists of Saint Louis, Missouri, with offices in Creve Coeur, Kirkwood, Florissant, and Washington, MO is focused on providing innovative solutions for prevalent women’s health conditions. Their purpose is to give practical, easy-to-understand facts so ladies, with their medical professionals, can consider their options and work out educated decisions.

What Is Stress Urinary Incontinence?

Stress Urinary Incontinence, or SUI, is the unexpected, unintended release of urine during normal, day to day activities. SUI is a different sort of condition compared to Overactive Bladder (OAB), a problem characterized by urgency, frequency, getting up at night with or without bladder seepage. Lots of women have both of the types of incontinence. You may have SUI should you lose urine when you:

  • Metropolitan Urological Specialists Metro Urology prostate cancer sexual health robotic prostatectomyCough, sneeze, or laugh
  • Walk, work out, or lift something
  • Rise from a sitting or lying position

It’s also possible to visit bathroom frequently each day to protect…

View original post 495 more words