OBESITYANDTHEURINARYTRACT
OBESITYANDTHEURINARYTRACT
• Kidneys:• Stones• Glomerulosclerosis
• Bladder• Incontinence• Urinarytractinfections
• Genitalia• Skinbreakdown• Phimosis• Disappears• Infertility• Hypogonadism• Prolapse• ED
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DICK
• 50yearoldMale• Presentswithrightloinpain
• Classicforrenalstones• “Similartolastlotofpain”
• Otherwise“well”• BMI>35
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• USS:• “difficultduetopatientsbodyhabitus,multiplesmallstonesrightkidney”
OBESITYANDSTONEDISEASE
• DICKWANTSTOKNOW..
• WHYDOC?• WhyamIgettingallthesestones?
• WHATCANIDO?• CanIchangemydiet?
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OBESITYANDSTONEDISEASE
• WHY???• IncreasedBMI=Increasedriskofstone
• Excessintakeoflithogenic substances• Refinedsugars• Lowfluidintake• Oxalatesrichfoods• Purinerichfoods
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OBESITYANDSTONEDISEASE
• WHY???
• IncreaseriskofUTI=Increaseriskofinfectionrelatedstones
• ReducedurinepH=Increasenumberofuricacidstones
• Treatments=Increaseoxalatebasedstones
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OBESITYANDSTONEDISEASE
• WHATCANIDO?• LOSEWEIGHT• Majorityoftheincreaseriskreturnstonormal
• ALTERDIET• Decreaseyouroxalateintake• Decreaseyourpurineintake• Balanceoutyourcalciumintake• INCREASEFLUIDINTAKE
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OBESITYANDSTONEDISEASE
• WHATDOESTHATACTUALLYMEAN?
• TryandgetpatientstoincreasetheirfluidintakeofWATERsothentheirurineisclearlooking
• AlterationsinthediettoPREVENTfurtherstones
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OBESITYANDSTONEDISEASE
DECREASEPURINERICHFOODSFORURICACIDSTONES
DECREASEOXALATERICHFOODSFORCALCIUMOXALATESTONES
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OBESITYANDSTONEDISEASE
• TREATTHECURRENTSTONES:• SendforUrologyreferral
• AllinterventionsarestillavailableforObesepatientsdependingon• 1.Anaesthetic risk• 2.SkintoStonedistancefortheequipment
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ANDALSO…IMREALLYWORRIEDABOUT…
• MYPENISITHASDISAPPEARED
• 31%=OBESE• 35%=OVERWEIGHT
• ADULTBURIEDPENISISANINCREASINGPROBLEM…
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OBESITYANDTHEDISAPPEARINGPENIS
• WHYISTHISAPROBLEM??• HYGIENE• SKINBREAKDOWN• PHIMOSIS• INCONTINENCE• “MISDIRECTEDFLOW”• RETENTION• SEXUALDYSFUNCTION• ERECTILEDYSFUNCTION• POSSIBLEPRECURSORTOSCCASSITTINGINMOISTENVIRONMENTCAUSINGMALADPATIVESKINCHANGES
• PSYCHOLOGICALHEALTH
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OBESITYANDTHEDISAPPEARINGPENIS
• SOWHYDOESTHISHAPPEN…• WITHINCREASEDWEIGHT• EXCESSIVEMOISTURE• PROMOTIONOFBACTERIALOVERGROWTH• TISSUEMACERATION• INFECTION
• LEADINGTOCHRONICCYCLEOFINFLAMMATION,SCARRING,ANDWORSENINGOFTHESKINANDFURTHERSHORTING
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OBESITYANDTHEDISAPPEARINGPENIS
• WHATCANIDODOC?
• WEIGHTLOSSANDEXERCISE!!
• NOMEDICALTHERAPIES
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OBESITYANDTHEDISAPPEARINGPENIS
• SURGERIES:
• MULTIPLEDIFFICULTOPERATIONSAVAILABLE• LIPOSUCTION,SKINGRAFTING,TRANSPOSITIONS…..
• RESULTSWITHUROLOGICALRECONSTRUCTIONSURGEONLIKEMYSELFAREGOODWORLDWIDE
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OBESITYANDTHEURINARYTRACT
• Unfortunately:
• Increasingepidemic• Increasingnumberofpatientseffected• Importanttotryandalterdietandfluidforpreventionaseasierthantreatment
• DR.ANNALAWRENCE• UROLOGIST• 0220489661• [email protected]• [email protected]