Volume 17, Number 3Review ArticlesMetabolic Syndrome and Nephrolithiasis Risk: Should the Medical Management of Nephrolithiasis Include the Treatment of Metabolic Syndrome?Patrick MufarrijJohn Michael DiBiancoTW JarrettThis article reviews the relationship between metabolic syndrome (MetS) and nephrolithiasis, as well as the clinical implications for patients with this dual diagnosis. MetS, estimated to affect 25% of adults in the United States, is associated with a fivefold increase in the risk of developing diabetes, a doubling of the risk of acquiring cardiovascular disease, and an increase in overall mortality. Defined as a syndrome, MetS is recognized clinically by numerous constitutive traits, including abdominal obesity, hypertension, dyslipidemia (elevated triglycerides, low high-density lipoprotein cholesterol), and hyperglycemia. Urologic complications of MetS include a 30% higher risk of nephrolithiasis, with an increased percentage of uric acid nephrolithiasis in the setting of hyperuricemia, hyperuricosuria, low urine pH, and low urinary volume. Current American Urological Association and European Association of Urology guidelines suggest investigating the etiology of nephrolithiasis in affected individuals; however, there is no specific goal of treating MetS as part of the medical management. Weight loss and exercise, the main lifestyle treatments of MetS, counter abdominal obesity and insulin resistance and reduce the incidence of cardiovascular events and the development of diabetes. These recommendations may offer a beneficial adjunctive treatment option for nephrolithiasis complicated by MetS. Although definitive therapeutic recommendations must await further studies, it seems both reasonable and justifiable for the urologist, as part of a multidisciplinary team, to recommend these important lifestyle changes to patients with both conditions. These recommendations should accompany the currently accepted management of nephrolithiasis. [Rev Urol. 2015;17(3):117-128 doi: 10.3909/riu0650] © 2015 MedReviews®, LLCMetabolic syndromeNephrolithiasisUric acid nephrolithiasis
Volume 19, Number 3Review ArticlesOsteitis Pubis: A Rare Cause of Suprapubic PainDiagnosis and Treatment ReviewPatrick MufarrijPatrick GomellaOsteitis pubis is a noninfectious inflammatory condition affecting the pubic symphysis. First described in a series of patients undergoing urologic procedures, it is an uncommon cause of lower abdominal and suprapubic pain. However, this condition can cause significant morbidity in patients affected, often requiring lengthy recovery periods. Given its rarity, the diagnosis and management is challenging, as many urologists are unfamiliar with the condition and may ascribe the constellation of symptoms as expected side effects from a recent surgical procedure. This review describes the urologic considerations for osteitis pubis, its potential etiologies, and clinical findings, and identifies treatment strategies for this potentially debilitating condition. [Rev Urol. 2017;19(3):156–163 doi: 10.3909/riu0767] © 2017 MedReviews®, LLCPostoperative painOsteitis pubisSuprapubic pain