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To evaluate the efficacy of non-narcotic analgesics and preoperative counseling in managing postoperative pain and narcotic use following ureteroscopic laser lithotripsy (URS).Adult patients at a single academic center undergoing URS for nephrourolithiasis were recruited. After informed consent, subjects were randomized into three groups: NARC-15 tablets oxycodone-acetaminophen 5/325 mg (A-OXY), 2. NSAID-15 tablets ibuprofen (IBU) 600 mg, 3. CNSL-15 tablets A-OXY, 15 tablets IBU, and preoperative counseling from the surgeon to avoid narcotic if possible. Patients who did not receive an intraoperative stent were excluded. At the time of stent removal subjects completed the Universal Stent Symptom Questionnaire (USSQ), and a pill count was performed. USSQ pain indices were the primary study endpoint.Of 115 patients enrolled, 104 met the primary endpoint and were included in the analysis. No significant differences were noted in patient demographic, clinical, or operative characteristics. No differences were noted in median USSQ pain indices. The CNSL group used a significantly lower median number of A-OXY pills compared to the NARC group (2.4 vs. 5.4, p = 0.001) and less IBU compared to the NSAID group (3.1 vs. 5.9, p = 0.008). No differences in median total pill count, office calls, medication requests, nor ED visits were noted.Our data suggest that patients can achieve equivalent postoperative analgesic satisfaction with non-narcotics compared to opiates following URS. Further, counseling patients on postoperative pain before surgery can reduce the total number of postoperative narcotic and non-narcotic medications taken. We suggest surgeons strongly consider omission of narcotic prescriptions following non-complicated URS.

Introduction An understanding of which trainee factors Endourology Society (ES) fellowship program directors (PDs) value may help urology residents optimize their fellowship candidacy and help current fellows optimize their fellowship performance. In the present study, we evaluated which factors are most important to ES PDs in selecting fellowship candidates and evaluating current fellows. Methods A survey was constructed using REDCap software and emailed to PDs of fellowships registered with the ES. Fellowships in the ES include Endourology-Stone Disease (ESD) programs, robotic-laparoscopic surgery programs (MIS), and combination programs. A Likert scale ranging from 1 (not important) to 5 (extremely important) was used to rank the criteria for selecting and evaluating fellows. The survey captured program demographics such as geographic region, program type, and program duration. Results Of the 52 ES PDs, 35 (67%) responded. Respondents represented 8 (23%) ESD programs, 7 (20%) MIS programs, and 20 (57%) combination programs. Furthermore, sixteen (46%) represented one-year programs and 19 (54%) represented two-year programs. The top-five factors for candidate selection were perceived fit of the applicant, perceived level of applicant interest, initial interview, personal emails from applicants' advocates, and personal phone calls from applicants' advocates. Advocacy on behalf of the applicant appeared to be especially important for two-year fellowships. The top-five factors for the evaluation of fellows in training were patient interactions, professionalism, attitude/demeanor, operative skills, and interactions with ancillary staff. Research productivity was of greater importance for the evaluation and selection of two-year fellows and ESD fellows. Conclusions Applicants for ES fellowships should focus on the initial interview and recruiting supportive mentors to advocate for their applications, particularly for two-year programs. Though PDs value both clinical skills and research productivity, research productivity was more important for two-year programs and ESD programs. Further research into applicant perspectives on the fellowship application process is warranted.

Purpose:Residual fragments following retrograde intrarenal surgery can lead to future stone episodes. The lower pole of the kidney presents a unique challenge as it is the most difficult location f...

To investigate the relationship between metabolic syndrome (MS) and urinary abnormalities in stone-forming patients. Additionally, to delineate whether severity of urinary derangements is impacted by the number of co-occurring MS components. Stone-forming patients who underwent initial metabolic workup prior to medical intervention at a comprehensive stone clinic were retrospectively reviewed and included in the study. Patients were given a six point (0–5) Metabolic Syndrome Severity Score (MSSS) based on the number of co-occurring MS components and split into six respective groups. Baseline clinical characteristics and metabolic profiles were compared between groups. Four-hundred-ninety-five patients were included in the study. Median age and median BMI was 58 years and 27.26 kg/m2, respectively. Several significant metabolic differences were noted, most notably a downward trend in median urinary pH (p

Objective To identify key papers in urology using a novel bibliometric index called the disruption score. Methods A PubMed search was conducted to identify papers published in Journal of Urology, European Urology, Urology, Urologic Oncology, Journal of Endourology, and BJU International, Nature Reviews Urology. Selected urology papers published in other medical journals were also included. Using a validated dataset of disruption scores for all papers published in 1954-2014, the top 100 most-disruptive urology papers, as well as the top 100 most-cited papers, were identified. Comparisons between both lists and across journals were investigated. Results A total of 72,623 published articles were included. Journal of Urology had the most articles in the most-disruptive papers list (n = 69) followed by BJU International (n = 16). New England Journal of Medicine had the most papers in the most-cited papers list (n = 26) followed by Journal of Urology (n = 23). Only 7 papers were common to both the most-disruptive papers and most-cited papers lists. Oncology was highly represented among the most-cited papers (n = 60), whereas the most-disruptive papers included a broader representation of urology. The most common study design among the most disruptive papers was small case-series/case reports, whereas the most common study design among the most-cited papers was randomized controlled trials. Conclusion The disruption score identified landmark papers in urology that have introduced innovative ideas. Disruption score captures a unique profile of scientific impact that may be used in combination with other bibliometric indices to identify scholarly achievements in urology.

The thulium fiber laser (TFL) is a novel technology under active investigation as an conceivable alternative to the Holmium:yttrium-aluminum-garnet (Ho:YAG) laser, which is currently the gold standard for an array of urologic procedures. The purpose of this review is to discuss the existing literature on the functionality and effectiveness of TFL in urological practice. We conducted a search of the PubMed, Medline, Web of Science Core Collection, SCOPUS, Embase (OVID), and Cochrane Databases for all full articles and systematic reviews on the TFL. We found a total of 35 relevant pieces of literature. The early research findings pertaining to the TFL exhibit numerous potential advantages over the Ho:YAG laser. In vitro and ex vivo studies have highlighted the TFL's ability to utilize smaller laser fibers, obtain faster stone ablation rates, and achieve less retropulsion when tested against the Ho:YAG laser in lithotripsy. Currently, there is limited in vivo research that investigates the utilization of the TFL. The in vivo results that are available, however, look promising both for laser lithotripsy and soft tissue ablation. Indeed, the existing literature suggests that the TFL has great potential and may possess numerous technological advantages over the Ho:YAG laser, especially in laser lithotripsy. Although these early studies are promising, randomized control trials are needed to assess the full applicability of the TFL in urology., Graphical Abstract

Background To evaluate Coronavirus Disease 2019-(COVID19) patients treated within our academic medical system to determine if history of malignancy, both in general and specifically in genitourinary oncology patients, is associated with adverse clinical outcomes, including acute kidney injury (AKI) and mortality. Methods We conducted a retrospective cohort study among patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a multi-hospital, academic medical institution in New York City. Outcomes included mortality, intensive care unit (ICU) admission and AKI among hospitalized patients. We also evaluated risk of hospitalization among all patients with SARS-CoV-2 infection. Multilevel logistic regression models were used for analysis. Results We identified 6,893 patients who met inclusion criteria, of which 4,018 were hospitalized. Among hospitalized patients 374 (9%) had a history of cancer, 281 (7%) experienced AKI, and 1,045 (26%) died. In adjusted analyses, patients with a history of cancer had 1.33 (95% CI = 1.05, 1.69) times the odds of death compared to those without cancer and this appeared to be driven by lung cancer (odds ratio (OR) = 2.44, 95% CI= 1.05, 4.39). Patients with a history of genitourinary cancer were not at higher risk of mortality compared to those without cancer (OR=0.99, 95% CI= 0.61, 1.62). History of cancer was not associated with ICU admission or AKI in overall and subgroup analyses. Conclusions Patients with a history of cancer who are hospitalized with SARS-CoV-2 infection are not at greater risk for AKI, though they are at higher risk for mortality as compared to patients without a history of cancer. The increased risk in mortality appears driven by patients with pulmonary neoplasms. Patients with a history of genitourinary malignancies do not appear to be at higher risk for AKI or for mortality compared to the general population.

COVID-19 has rapidly evolved into a global pandemic. In an attemp to reduce transmission, patients were advised to avoid in-person medical evaluations when possible. Accordingly, we hypothe...

Background The United States healthcare landscape has witnessed numerous changes since implementation of the Affordable Care Act coupled with rising prevalence of upper urinary tract stone disease. Data on the economic burden of stone disease during this period are lacking, providing the objective of our study. Materials and Methods Adults diagnosed with stone disease from 2011-2018 were identified from PearlDiver Mariner, a national all-payer database reporting reimbursements and prescription costs for all healthcare encounters. Patients undergoing operative and non-operative care were identified. Time trends in annual expenditures were evaluated. Multivariable analysis evaluated determinants of spending. Results A total of $10B were spent on stone disease management between 2011-2018 (median overall annual expenditure=$1.4B) among 786,756 patients. Inpatient, prescription and outpatient costs accounted for 34.7%, 20.7% and 44.6% of expenditures respectively. 78% of patients were managed non-operatively (total cost=$6.9B). Average overall cost per encounter was $13,587 ($17,102 for surgical vs. $11,174 for non-surgical care). Expenditures on inpatient care decreased significantly over time, while expenditures on prescriptions and outpatient care increased significantly. On multivariable analysis, higher Charlson Comorbidity Index was associated with higher spending, while associations for age, insurance and region varied by treatment modality. Conclusions The economic burden of stone disease management is substantial, dominated by expenditure on non-operative management and outpatient care. Expenditures for prescription and outpatient care are rising, with the only consistent predictor of higher spending being Charlson Comorbidity Index. Spending variation according to demographic, clinical, and geographic factors was evident.

Treatment delays in muscle invasive bladder cancer (MIBC) have been shown to be associated with worse outcomes. While every attempt is made to provide adequate treatment expeditiously, Black and Hispanic patients often experience delays at a higher rate than their White counterparts. This study aims to quantify the mechanisms that contribute to this disparity in treatment delay.Retrospective analysis of clinical T-stages II-IVa MIBC patients who underwent surgical resection from 2004 to 2017 in the National Cancer Database. A causal inference mediation analysis using the counterfactual framework was implemented to estimate the extent to which racial/ethnic disparities in patient and system factors explain the racial/ethnic disparities in time to treatment. Mediators included income, education, comorbidities, insurance, and hospital type.Among 22,864 patients who met inclusion criteria, 7%, 3%, 2% were of Black, Hispanic, and Other race/ethnicity, respectively. In multivariable models, compared to White patients, Black, and Hispanic patients were associated with 26% (odds ratio = 1.26, 95% confidence interval = 1.12-1.42) and 29% (odds ratio = 1.29, 95% confidence interval = 1.07-1.55) increased odds of having a treatment delay relative to White patients. Mediation analyses suggested that 49% and 26% the treatment delay among Black and Hispanic patients, respectively, could be removed if an intervention equalized the distribution of academic treatment, education, and insurance status to that of White patients. Treatment at an academic hospital and education were the mediators that explained the largest portion of the racial/ethnic disparity in treatment delay.Black and Hispanic MIBC patients experience treatment delays when compared to White patients. Intervening upon patient and system factors could reduce substantial treatment delays. Future research is needed to identify other causes of disparities in treatment delays and may help population health initiatives to address racial/ethnic disparities in clinical settings.

Introduction: Diabetes mellitus (DM) is associated with an increased risk of nephrolithiasis and is often treated with metformin. The relationship between metformin and nephrolithiasis formation remains unclear as studies have demonstrated conflicting results. Methods: We conducted a cross-sectional analysis of stone-forming patients at our stone clinic prior to the initiation of stone-directed medical management. Patients were grouped based on diabetic status and diabetic medication regimen. Outcomes evaluated were 24-hour urinary parameters and specimen stone type using univariate Kruskal-Wallis and Chi-squared analyses. Multivariate analyses controlling for metabolic syndrome components and HbA1c were performed. Results: Data were available for 505 patients, of whom 147 were diabetic and 358 were not. On multivariate analyses controlling for HbA1c and other comorbidities, diabetic patients on metformin still had worse urinary parameters, including urine pH, than non-diabetic patients (pH = -0.33, -0.37, p0.05 for all urinary parameters). Conclusions: Stone-forming patients with DM on metformin were associated with urinary abnormalities similar to those not on metformin. Cohort studies comparing urinary parameters of patients prospectively started on metformin are necessary to further elucidate metformin’s role, if any, in combatting nephrolithiasis.

INTRODUCTION AND OBJECTIVE:Minimizing retropulsion may improve surgical efficiency during ureteroscopic lithotripsy. This study seeks to determine if reverse Trendelenburg (RT) positioning during u...

INTRODUCTION AND OBJECTIVE:Percutaneous nephrolithotomy (PCNL) can be performed in the prone or supine position. Proponents of supine claim it is less invasive and requires less anesthesia. For the...

Purpose of Review The COVID-19 pandemic brought unprecedented challenges for urology resident education. In this review, we discuss the pandemic’s impact on urology trainees and their education. Recent Findings Urology trainees were often redeployed to frontline services in unfamiliar clinical settings. Residents often experienced increased levels of stress, anxiety, and depression. Many programs instituted virtual “check-ins” and formed liaisons with mental health services to foster cohesiveness. Urology trainees experienced the integration of telehealth into the clinical realm. Virtual surgery lectures and simulations were utilized to augment surgical education. Academic governing bodies upheld resident protections and provided dynamic guidance for training requirement throughout the pandemic. Medical students were unable to participate in traditional in-person away rotations and interviews, complicating the residency application process. Summary The COVID-19 pandemic shook the healthcare system and ushered in seismic changes for urology trainees worldwide. Though the longstanding effects of the pandemic remain to be seen, urology residents have demonstrated tremendous resilience and bravery throughout this challenging period, and those qualities will undeniably withstand the test of time.

Here we present the case of a 78-year-old medically comorbid woman with an extremely large bladder stone burden treated by cystolithalopaxy performed using a Swiss LithoClast(®) Trilogy Lithotripter (Boston Scientific, Marlborough, MA, USA) through a nephroscope traversing a transurethral Amplatz sheath.

The urinary tract is highly innervated by autonomic nerves which are essential in urinary tract development, the production of growth factors, and the control of homeostasis. These neural signals may become dysregulated in several genitourinary (GU) disease states, both benign and malignant. Accordingly, the autonomic nervous system is a therapeutic target for several genitourinary pathologies including cancer, voiding dysfunction, and obstructing nephrolithiasis. Adrenergic receptors (adrenoceptors) are G-Protein coupled-receptors that are distributed throughout the body. The major function of α1-adrenoceptors is signaling smooth muscle contractions through GPCR and intracellular calcium influx. Pharmacologic intervention of α-and β-adrenoceptors is routinely and successfully implemented in the treatment of benign urologic illnesses, through the use of α-adrenoceptor antagonists. Furthermore, cell-based evidence recently established the antitumor effect of α1-adrenoceptor antagonists in prostate, bladder and renal tumors by reducing neovascularity and impairing growth within the tumor microenvironment via regulation of the phenotypic epithelial-mesenchymal transition (EMT). There has been a significant focus on repurposing the routinely used, Food and Drug Administration-approved α1-adrenoceptor antagonists to inhibit GU tumor growth and angiogenesis in patients with advanced prostate, bladder, and renal cancer. In this review we discuss the current evidence on (a) the signaling events of the autonomic nervous system mediated by its cognate α- and β-adrenoceptors in regulating the phenotypic landscape (EMT) of genitourinary organs; and (b) the therapeutic significance of targeting this signaling pathway in benign and malignant urologic disease. Video abstract Supplementary Information The online version contains supplementary material available at 10.1186/s12964-021-00755-6.

Aim To determine short-term efficacy and safety of Paxerol®, novel immediate:sustained (50%:50%) release tablets containing 325 mg acetaminophen and 150 mg ibuprofen per tablet. Methods One of three dose levels, corresponding to the amounts in 1, 2, and 3 tablets, of Paxerol and placebo were administered for 14 consecutive days to patients with severe nocturia (defined in this study as an average nocturnal voids [NV] ≥2.5) associated with overactive bladder (OAB). Changes in NV, as well as Nocturia Quality of Life (NQOL), duration of first uninterrupted sleep (DFUS), and total hours of nightly sleep (THNS) associated with treatment were assessed. Short-term safety/tolerability was assessed throughout the study and for at least 30 days post-treatment. Results Paxerol at all three doses reduced NV to a greater degree than placebo (average NV -1.1, -1.4, -1.3 voids for low, mid, and high doses, respectively, vs -0.3 void for placebo). NQOL and THNS were similar between baseline and treatment values in all four groups. There were also no between-group differences. Paxerol at high dose tended to (although not statistical significantly) increase DFUS to a greater degree than placebo (1.2 vs 0.4 h, P = 0.057). There were no treatment related adverse events in any of the four groups. Conclusions This study demonstrates short-term efficacy and short-term safety of Paxerol in patients with severe nocturia associated with OAB. The results warrant further investigation of the long-term efficacy and safety of Paxerol in larger patient populations.

To investigate the relationship between metabolic syndrome (MS) and urinary abnormalities in stone-forming patients. Additionally, to delineate whether severity of urinary derangements is impacted by the number of co-occurring MS components.Stone-forming patients who underwent initial metabolic workup prior to medical intervention at a comprehensive stone clinic were retrospectively reviewed and included in the study. Patients were given a six point (0-5) Metabolic Syndrome Severity Score (MSSS) based on the number of co-occurring MS components and split into six respective groups. Baseline clinical characteristics and metabolic profiles were compared between groups.Four-hundred-ninety-five patients were included in the study. Median age and median BMI was 58 years and 27.26 kg/mPrior research has attributed the strong association of nephrolithiasis and MS to high prevalence of UA nephrolithiasis and low urinary pH. Our findings indicate that all MS components with the exception of hyperlipidemia were independently associated with low urinary pH suggesting a mechanism independent from insulin resistance.

Background The rapid spread of COVID‐19 has placed tremendous strain on the American healthcare system. Few prior studies have evaluated the well‐being of or changes to training for American resident physicians during the COVID‐19 pandemic. We aim to study predictors of trainee well‐being and changes to clinical practice using an anonymous survey of American urology residents. Methods An anonymous, voluntary, 47‐question survey was sent to all ACGME‐accredited urology programs in the United States. We executed a cross‐sectional analysis evaluating risk factors of perception of anxiety and depression both at work and home and educational outcomes. Multiple linear regressions models were used to estimate beta coefficients and 95% confidence intervals. Results Among approximately 1,800 urology residents in the USA, 356 (20%) responded. Among these respondents, 24 had missing data leaving a sample size of 332. Important risk factors of mental health outcomes included perception of access to PPE, local COVID‐19 severity, and perception of susceptible household members. Risk factors for declination of redeployment included current redeployment, having children, and concerns regarding ability to reach case minimums. Risk factors for concern of achieving operative autonomy included cancellation of elective cases and higher level of training. Conclusions Several potential actions, which could be taken by urology residency program directors and hospital administration, may optimize urology resident well‐being, morale, and education. These include advocating for adequate access to PPE, providing support at both the residency program and institutional levels, instituting telehealth education programs, and fostering a sense of shared responsibility of COVID‐19 patients.

Introduction: We compared characteristics of patients undergoing prostate biopsy in a high-risk inner city population before and after the 2012 USPSTF recommendation against PSA based prostate cancer screening to determine its effect on prostate biopsy practices. Materials and Methods: This was a retrospective study including patients who received biopsies after an abnormal PSA measurement from October 2008-December 2015. Patients with previously diagnosed prostate cancer were excluded. Chi-square tests of independence, two sample t-tests, Mann-Whitney U tests, and Fisher's exact tests were performed. Results: There were 202 and 208 patients in the pre-USPSTF and post-USPSTF recommendation cohorts, respectively. The post-USPSTF cohort had higher median PSA (7.8 versus 7.1ng/mL, p=0.05), greater proportion of patients who were black (96.6% versus 90.5%, p=0.01), and greater percentage of biopsy cores positive for disease (58% versus 29.5%, p

A recent study demonstrated improvement in nocturnal urgency in patients with overactive bladder when treated with fesoterodine. In the current study we aimed to determine which bladder diary parameters predict the response to fesoterodine in these patients.Patients with nocturnal urgency completed a 2-week, single-blind placebo run-in followed by 1:1 double-blind randomization to 12 weeks of fesoterodine or placebo. We analyzed bladder diary parameter changes from baseline to week 12, including the actual number of night voids (total number of nocturia episodes), maximum voided volume, nocturnal bladder capacity, Nocturnal Bladder Capacity Index (NBCi) (actual number of night voids - nocturnal urine volume/maximum voided volume - 1), nocturnal urine volume, the nocturia index (nocturnal urine volume/maximum voided volume) and the nocturnal polyuria index (nocturnal urine volume/24-hour volume). Additionally, we analyzed OAB-q (Overactive Bladder Questionnaire) changes.There was a linear relationship between the likelihood of being a responder for NBCi and the nocturia index. Responders had a significant decrease in nocturnal urine volume relative to baseline (-181.7 ml, p0.01). Neither group showed a significant change in maximum voided volume relative to baseline. There was a significant decrease in NBCi and the nocturia index in responders (-0.82 and -0.61, respectively, each p0.01). Responders demonstrated improvement in the OAB-q concern, coping, sleep, bother and total score metrics.Patients with nocturnal urgency secondary to overactive bladder syndrome and low nocturnal bladder capacity with a mismatch between nocturnal urine production and bladder capacity may benefit from fesoterodine. Symptom improvement appears to be mediated by increases in typical rather than maximum nocturnal voided volumes. Symptom improvement was associated with improved quality of life.

Introduction:The Foley catheter has been widely assumed to be an effective means of draining the bladder. However, recent studies have brought into question its efficacy. The objective of our study is to further assess the adequacy of Foley catheter for complete drainage of the bladder.Materials and Methods:Consecutive catheterized patients were identified from a retrospective review of contrast enhanced and non-contrast enhanced computed tomo-graphic (CT) abdomen and pelvis studies completed from 7/1/2011-6/30/2012. Residual urine volume (RUV) was measured using 5mm axial CT sections as follows: The length (L) and width (W) of the bladder in the section with the greatest cross sectional area was combined with bladder height (H) as determined by multiplanar reformatted images in order to calculate RUV by applying the formula for the volume (V) of a sphere in a cube: V=(ϖ/6)*(L*W*H).Results:RUVs of 167 (mean age 67) consecutively catheterized men (n=72) and women (n=95) identified by CT abdomen and pelvis studies were calculated. The mean RUV was 13.2 mL (range: 0.0 mL-859.1 mL, standard deviation: 75.9 mL, margin of error at 95% confidence:11.6 mL). Four (2.4%) catheterized patients had RUVs of >50 mL, two of whom had an improperly placed catheter tip noted on their CT-reports.Conclusions:Previous studies have shown that up to 43% of catheterized patients had a RUV greater than 50 mL, suggesting inadequacy of bladder drainage via the Foley catheter. Our study indicated that the vast majority of patients with Foley catheters (97.6%), had adequately drained bladders with volumes of

Objective. Nocturia may be characterized by indices derived from the frequency-volume chart (FVC). The objective of this study was to determine how these parameters relate to the severity of nocturia in men with and without lower urinary tract symptoms (LUTS). Materials and methods. A retrospective analysis of FVCs was performed in two cohorts of men: those presenting with LUTS in a New York ambulatory urology clinic and those from the longitudinal population-based Krimpen study. Nocturnal urine volume (NUV), nocturia index (Ni), nocturnal polyuria index (NPi), nocturnal maximal voided volume (nMVV) and sleep duration were derived from FVCs. Comparisons were made using Spearman's rank correlation coefficient between actual number of nightly voids (ANV) and the other diary parameters. Results. Eighty-eight consecutive men who presented with LUTS completed a 24 h FVC [median age 70 years, interquartile range (IQR) 64.5-74.5, median ANV 2, IQR 1.5-4]. Nocturnal voiding frequency and volume were analyzed in 1082 community-dwelling men (median age 61 years, IQR 56.1-66.4, range 49.4-78.2; median ANV 1.5, IQR 1.0-2.0, range 0-4.5). Both cohorts demonstrated strong correlations between nocturia severity (represented as ANV) and Ni (0.797, 0.658 for cohorts 1 and 2, respectively). There were moderate correlations between nocturia severity and NPi (0.545, 0.394), NUV (0.463, 0.432) and sleep duration (0.306, 0.272). The nMVV correlated poorly with nocturia severity (0.159, 0.146). Conclusions. Treatment of nocturia should aim to match nocturnal urine production with bladder capacity. Given the lack of known effective pharmacotherapy for low bladder volume, the first attempt nocturia treatment could focus on volume reduction.

Osteoporosis is a ubiquitous disease, with a prevalence of 200,000,000 cases worldwide. In these cases, bone density is at least 2.5 standard deviations below the global mean. While this debilitating condition affects both genders, women are disproportionately afflicted due to post-menopausal hormonal changes. Accordingly, fractures of the hip are a common cause of morbidity and mortality among females, and as such have been well documented. It is hypothesized that the hypoestrogenic state of post-menopausal women will result in a lower bone density than that of their male counterparts. This investigation examined density changes in the lesser studied mandibular corpus as a function of age for each gender. The mandibular condyle was removed from 12 cadavers, obtaining mass and volume by digital scale and water displacement respectively, and the calculation of their densities. Our findings showed that bone density increased with increasing age (r = 0.47). However, when measures were subdivided by gender, b...