Purpose To investigate the risk of symptomatic urolithiasis requiring surgical treatment according to obesity and metabolic health status using a nationwide dataset of the Korean population. Materials and Methods Of the 5,300,646 persons who underwent health examinations between the year 2009 and 2016, within one year after the health examination, 35,137 patients who underwent surgical treatment for urolithiasis were enrolled. Participants were classified as “obese” or “non-obese” using a body mass index (BMI) cutoff of 25 kg/m 2 . People who developed ≥1 metabolic disease component in the index year were considered “metabolically unhealthy”, while those with none were considered “metabolically healthy”. Results Out of 34,330 participants excluding 843 missing, 16,509 (48.1%), 4,320 (12.6%), 6,456 (18.8%), and 7,045 (20.5%) subjects were classified into the metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) group, respectively. Mean BMI was 22.1±1.9 kg/m 2 , 22.9±1.6 kg/m 2 , 26.9±1.8 kg/m 2 , and 27.9±2.4 kg/m 2 respectively. After adjusting the age and sex, the subjects in the MUNO group had an HR (95% CI) of 1.192 (1.120–1.268), those in the MHO group, 1.242 (1.183–1.305), and those in the MUO group, 1.341 (1.278–1.407) for either extracorporeal shockwave lithotripsy or surgery, compared to those in the MHNO group. Conclusions Metabolically healthy, obese individuals have a higher risk of developing symptomatic urolithiasis than non-obese, unhealthy, but have a lower risk than obese, unhealthy. It suggests that metabolic health and obesity have collaborative effects, independently affecting the development of symptomatic urinary stone diseases.

Background Demographic change and advances in technology affect transurethral surgery and outpatient procedures in the urologic field. There are few population-based studies that accurately assess the trend of transurethral surgery and outpatient procedures including diagnostic tests. We investigated the recent epidemiologic trends in transurethral surgeries and urological outpatient procedures from 2009 to 2016 in Korea using the entire population-based cohort. Methods We analyzed medical service claim data of transurethral surgery, urological outpatient procedures submitted by medical service providers from the Health Insurance Review and Assessment Service from 2009 to 2016. Results Transurethral ureter surgery increased by 134.9% from 14,635 in 2009 to 34,382 in 2016 (B = 2,698; R 2 = 0.98; P < 0.001). The transurethral bladder surgery increased by 65.5% from 12,482 in 2009 to 20,658 in 2016 (B = 1,149; R 2 = 0.97; P < 0.001). Over the 8-years period, there were not significant changes in transurethral prostate (B = 43; R 2 = 0.04; P = 0.617) and urethral surgery (B = −12; R 2 = 0.18; P = 0.289). The significantly increasing trends in cystoscopy (B = 5,260; R 2 = 0.95; P < 0.001) and uroflowmetry (B = 53,942; R 2 = 0.99; P < 0.001) were observed during the 8-year period. There was no difference in bladder catheterization during the 8-year period. Urodynamic study (UDS: B = −2,156; R 2 = 0.77; P = 0.003) and electrical stimulation treatment (EST: B = −1,034; R 2 = 0.87; P < 0.001) significantly decreased. Conclusion In Korea, transurethral ureter surgery and transurethral bladder surgery have been continuously increasing. Transurethral prostate surgery and transurethral urethral surgery remained constant with no increase or decrease. Cystoscopy and uroflowmetry continue to increase, while UDS and EST continue to decrease.

To compare off-clamp vs on-clamp robotic partial nephrectomy (RPN) in terms of oncological outcomes, and to assess the interaction between hilar control approach and surgical experience regarding oncological outcomes.METHODS: A contemporary cohort of 1370 patients from nine institutions who underwent RPN was extracted from the prospectively maintained database of the national French network of research on kidney cancer (UROCCR).Patients' characteristics were evaluated: age, sex, BMI, ECOG, Tumor size, TNM and R.E.N.A.L score. The different types of hilar control approach (off-clamp vs on-clamp) were compared regarding oncological outcomes. Primary endpoint was the positive surgical margins (PSM) rate, and secondary endpoints were local recurrence, overall survival and metastasis-free survival.To evaluate the oncological outcomes regardless of the surgical experience (SE), that we thought could be a confounding factor, we divided patients into three groups according to the caseload of RPN per surgeon per year: Low SE (<15/S/Y -n[ 89), moderate SE (15-30/S/Y-n[ 369), and high SE (>30/S/Y -n[ 912), and compared PSM rate into each sub-group depending on the type of hilar control approach. For continuous variables we used Mann-Whitney and Student tests; for discrete variables, Chi2 and Kruskal-wallis; Kaplan Meier with log-rank test for survival analysis; as well as a logistic regression model for multivariate analysis. Statistical significance was set for p<0.05 RESULTS: 1370 patients were pooled (1146 on-clamp vs 224 off-clamp). No statistically significant differences were found in key patients' characteristics. Positive surgical margins (PSM) rates were 6,6 % in the off-clamp group vs 14% in the on-clamp group (P [0,103). There were no statistically significant differences in overall survival (P[0,623), local recurrence (P[0,391), or metastasis free survival (P[0,424). After stratification according to SE, PSM rate was not affected by the type of hilar control approach in the three subgroups (P[1.00; 0.08; 0.2, respectively). On multivariate analysis assessing SE, hilar control approach, T stage, Tumor size, RENAL scores. SE, Age, and Tumor size were associated with oncological outcomes (OR-P[ 0,64-0,02; 1,02-0,02; 1,12-0,04) respectively.CONCLUSIONS: There is no impact of hilar control approach on oncological outcomes in patients treated with RPN. Randomized controlled trials are still awaited to confirm our findings.