Tag Archives: comorbidities

The Impact of Comorbidities on the Efficacy of Percutaneous Nephrolitotomy (PCNL) in Elderly Patients

DOI: 10.1515/amma-2016-0025

Introduction: The objective of this study is to evaluate the efficacy and safety of PCNL as a method of treatment of renal stones in elderly patients.
Material and method: This was a retrospective study conducted over a period of 5 years in the Clinic of Urology, where we analyzed the surgical protocols and case reports of 56 patients who underwent PCNL intervention.
Results: The incidence of urolithiasis was higher in females 69.6 % (n = 39) than in males 30.4 % (n = 17). Comorbidities included hypertension (48.2 %), chronic ischemic cardiopathy (28.6 %), chronic cardiac failure (16.1 %), type II diabetes (17.9 %), obesity (39.3 %), chronic renal failure (8.9 %), chronic or recurrent urinary tract infections (30.4 %), history of kidney stones (21.4 %) , solitary kidney surgery (1.8%), renal malformation (horseshoe kidney and renal incomplete duplication) (3.6 %), urethral stricture (3.6 %). Nine patients had a duble “J” catheter inserted on admission. The group of male patients presented prostate hyperplasia in 35.3 % of the cases and prostate carcinoma in 5.9 % of the cases.
Conclusions: PCNL is an effective and safe treatment of kidney stones in elderly patients, with a stone- free rate increased despite existing comorbidities. The presence of comorbidities requires careful preoperative evaluation. PCNL in elderly patient has similar results to those seen in younger patients.

Full text: PDF

Obesity Treatment Strategies

DOI: 10.1515/amma-2015-0076

Obesity is a disease with severe health consequences and increased risk of mortality. The most commonly used criteria to assess the presence and the severity of obesity are body mass index, waist circumference, waist-to-height ratio and the presence of the health conditions caused or worsened by obesity. Worldwide obesity has more than doubled in the last 4 decades. Obesity is the second of the leading preventable causes of death worldwide (after smoking). Obesity has a plurifactorial pathogenesis. The central perturbation consists in the imbalance between calories intake and calories consumption (by inappropriate diet and sedentary lifestyle). Identification of all the ethiological factors is important for treatment and prophylaxis. Weight loss benefits are multiple and important: improvement in glicemic control and in plasma lipid levels, blood presure control, obstructiv sleep apneea reduction, improvement in management of daily activities and profesional performances, increase quality of life, reduction in mortality. Overweight or obese patient will complete a diagnostic and a treatment program. Treatment of obesity claims a targeted multidimensional therapy: weight and lifestyle management, diet, sustained physical activity in daily life, exercise, decrease life stressors, smoking cessation, drug therapy, bariatric surgery psichological, familial and social suport. Weight loss program must be carefully planned, adapted to the patient’s abilities and comorbidities and supervised by a nutritionist and a physiotherapist.

Full text: PDF