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Re: Urolithiasis is Associated with an Increased Risk of Stroke: A Population-Based 5-Year Follow-up Study.

available at http://www.ncbi.nlm.nih.gov/pubmed/28892297 Editorial Comment: Urolithiasis is one of the most common urological conditions, and overall incidence rates among elderly and younger patients are similar. Emerging data suggest an association between increased rates of cardiovascular disease in patients with a history of urinary stone disease. This study examined data from a national population database to determine if there is a similar association between urolithiasis and ischemic or hemorrhagic stroke. The observed overall hazard ratio for stroke was 1.19 times higher in patients with urolithiasis compared to the nonstone group (95% CI 1.10 to 1.29, p <0.001). It is not really possible to identify causality using this study methodology, but the observed association is intriguing. It is hypothesized that cerebral atherosclerosis may share some common underlying mechanisms with urolithiasis, particularly in terms of primary stone formation in the renal papilla and deposition of plaque in blood vessels. Oxidative stress and inflammation may have an important role in both processes. In addition, there is strong overlap between urolithiasis and stroke, and multiple other comorbid conditions. However, in this study risk of stroke remained greater in those with stones even after controlling for coexisting diabetes, hyperlipidemia and hypertension. Future work will need to examine not only the epidemiological associations, but also ways to help prevent or limit the potential for stroke and stones in at risk patients. Tomas L. Griebling, MD, MPH Suggested Reading Reiner AP, Kahn A, Eisner BH et al: Kidney stones and subclinical atherosclerosis in young adults: the CARDIA study. J Urol 2011; 185: 920. Stoller ML, Meng MV, Abrahams HM et al: The primary stone event: a new hypothesis involving a vascular etiology. J Urol 2004; 171: 1920. Re: Disproportionate Use of Inpatient Care by Older Adults with Kidney Stones E. B. Cone, B. G. Hammill, J. C. Routh, M. E. Lipkin, G. M. Preminger, K. E. Schmader and C. D. Scales, Jr. Department of Surgery, Division of Urology, and Departments of Medicine and Pediatrics, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, and Geriatric Research Education and Clinical Center, Durham VA Medical Center, Durham, North Carolina Urology 2018; 120: 103e108. doi: 10.1016/j.urology.2018.06.007 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/29940233available at http://www.ncbi.nlm.nih.gov/pubmed/29940233 Editorial Comment: Stone disease can occur at any age, and many patients who experience stones at a younger age may have recurrence later in life. This study examined similarities and differences in patterns of inpatient care and costs associated with treatment for stone disease in geriatric and younger patients. Data were obtained from the Nationwide Inpatient Sample during a 5-year period. Information from more than 1.7 million hospital discharges was examined. Older adults (age 65 years or older) accounted for 32.4% of patients. However, they accounted for substantially greater overall costs, length of stay and need for postdischarge skilled nursing or home care. Not surprisingly, 72% of older adults had at least 1 comorbid condition based on Charlson Comorbidity Index scoring. Increased resource utilization by older compared to younger adults was seen even after controlling for important confounders such as geographic location and hospital type and 8 GERIATRICS Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.