Chronic emotional stress is associated with increased cortisol release and metabolism disorders. However, few studies have evaluated the influence of chronic stress on calcium oxalate (CaOx) stone disease and its recurrence. A total of 128 patients were enrolled in this case-control study over a period of 20 months. All patients were CaOx stone formers with a recent stone episode (<3 months); 31 were first-time stone formers (FS) and 33 recurrent stone formers (RS). Dimensions of chronic stress were evaluated with self-reported validated questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout and satisfaction with life. An ad hoc self-reporting questionnaire was designed to evaluate stress-related specifically to stone episodes. Blood and urine samples were collected to determine cortisol levels and urinary composition. In addition, epidemiological data, socioeconomic information, diet and incidences of metabolic syndrome (MS) were reported. Overall, no significant differences were observed in the scores of cases and controls on any of the questionnaires dealing with stress. The number (p < 0.001) and the intensity (p < 0.001) of perceived stressful life events were higher in RS than in FS, but there were no differences between the two groups in other dimensions of stress. RS had higher glucose (p = 0.08), uric acid (p = 0.02), blood cortisol (p = 0.01), and urine calcium levels (p = 0.01) than FS. RS also had lower economic levels (p = 0.02) and more frequent incidences of MS (p = 0.07) than FS. Although no differences were observed in cases and controls among any dimension of chronic stress, the number and intensity of stressful life events were higher in RS than in FS. These differences correlate with variations in blood and urinary levels and with metabolic disorders, indicating an association between chronic stress and risk of recurrent CaOx stone formation.

Whichever the considered diagnostic criteria, the prevalence of the metabolic syndrome in this area of the Canary Islands is greater than that observed in most other European populations.

PURPOSE: To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL) on lower calyceal calculi in relation to the renal anatomical factors and determine which of these factors can be used to select patients who will benefit from SWL. MATERIAL AND METHODS: We analyzed retrospectively 78 patients with single radiopaque lower calyceal stones treated with SWL. The patients were evaluated 3 months after lithotripsy with a simple abdominal X-ray and a kidney ultrasound scan. The success of the treatment, removal of all fragments, was correlated with renal anatomical factors measured in the pre-treatment intravenous urography: infundibulopelvic angle, lower infundibulum width, lower infundibulum length, ratio length/width, infundibulum height, and number of minor calyces in the lower calyceal group. RESULTS: Three months after SWL treatment, 39 patients were stone-free (NR group) and 39 had residual fragments (R group). Both groups presented no differences in relation to infundibulopelvic angle, width and length of the lower calyceal infundibulum, length/width ratio of the lower infundibulum or number of lower calyces. Height of the infundibulum, described as the distance between the line passing through the lowest part of the calyx containing the calculus and the highest point of the lower lip of renal pelvis, was the only parameter in which significant differences (p = 0.002) were found between the NR and R groups. CONCLUSIONS: Lower Infundibular height could be a good measurement tool for deciding which patients with lower calyceal lithiasis would benefit from SWL treatment. Height of less than 22 mm suggests a good outcome from lithotripsy

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MR and MR spectroscopy combined with free-to-total PSA ratio improves the predictive value for prostate cancer detection.