The effect of a multidisciplinary weight loss program on renal circadian rhythm in obese adolescents

Adolescent obesity is a serious health problem associated with many comorbidities. Obesity-related alterations in circadian rhythm have been described for nocturnal blood pressure and for metabolic functions. We believe renal circadian rhythm is also disrupted in obesity, though this has not yet been investigated. This study aimed to examine renal circadian rhythm in obese adolescents before and after weight loss. In 34 obese adolescents (median age 15.7 years) participating in a residential weight loss program, renal function profiles and blood samples were collected at baseline, after 7 months, and again after 12 months of therapy. The program consisted of dietary restriction, increased physical activity, and psychological support. The program led to a median weight loss of 24 kg and a reduction in blood pressure. Initially, lower diurnal free water clearance (- 1.08 (- 1.40-- 0.79) mL/min) was noticed compared with nocturnal values (0.75 (- 0.89-- 0.64) mL/min). After weight loss, normalization of this inverse rhythm was observed (day - 1.24 (- 1.44-1.05) mL/min and night - 0.98 (- 1.09-- 0.83) mL/min). A clear circadian rhythm in diuresis rate and in renal clearance of creatinine, solutes, sodium, and potassium was seen at all time points. Furthermore, we observed a significant increase in sodium clearance. Before weight loss, daytime sodium clearance was 0.72 mL/min (0.59-0.77) and nighttime clearance was 0.46 mL/min (0.41-0.51). After weight loss, daytime clearance increased to 0.99 mL/min (0.85-1.17) and nighttime clearance increased to 0.78 mL/min (0.64-0.93). Conclusion: In obese adolescents, lower diurnal free water clearance was observed compared with nocturnal values. Weight loss led to a normalization of this inverse rhythm, suggesting a recovery of the anti-diuretic hormone activity. Both before and after weight loss, clear circadian rhythm of diuresis rate and renal clearance of creatinine, solutes, sodium, and potassium was observed.What is Known:center dot Obesity-related alterations in circadian rhythm have been described for nocturnal blood pressure and for metabolic functions. We believe renal circadian rhythm is disrupted in obesity, though this has not been investigated yet.What is New:center dot In obese adolescents, an inverse circadian rhythm of free water clearance was observed, with higher nighttime free water clearance compared with daytime values. Weight loss led to a normalization of this inverse rhythm, suggesting a recovery of the anti-diuretic hormone activity.center dot Circadian rhythm in diuresis rate and in the renal clearance of creatinine, solutes, sodium, and potassium was preserved in obese adolescents and did not change after weight loss

Holmium Laser Enucleation of the Prostate vs Robot-Assisted Simple Prostatectomy for Lower Urinary Tract Symptoms in Patients with Extremely Large Prostates ≥200 cc: A Comparative Analysis

Introduction and Objectives: Robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP) are both well-established, minimally invasive surgical treatment options for lower urinary tract symptoms caused by benign prostatic enlargement. We have reported the first comparative analysis of both techniques in patients with prostates of & GE;200 cc.Materials and Methods: Between 2009 and 2020 a total of 53 patients with a prostate volume of & GE;200 cc were surgically treated at OLV Hospital Aalst (Belgium): 31 underwent RASP and 22 underwent HoLEP. Preoperative and postoperative assessments included uroflowmetry with maximum urinary flow rate (Qmax) and postvoid residual volume (PVR), as well as the International Prostate Symptom Score (IPSS) and quality of life (IPSS-QoL). The complication rates were evaluated according to the Clavien-Dindo Classification.Results: Patients treated with RASP had significantly larger prostate volumes compared with HoLEP (median 226 cc vs 204.5 cc, p = 0.004). After a median follow-up of 14 months, both groups showed a significant improvement in the maximum flow rate (+10.60 mL/s vs +10.70 mL/s, p = 0.724) and a reduction of the IPSS score (-12.50 vs -9, p = 0.246) as well as improvement of the QoL (-3 vs -3, p = 0.880). Median operative time was similar in both groups (150 minutes vs 132.5 minutes, p = 0.665). The amount of resected tissue was lower in the RASP group (134.5 g vs 180 g, p = 0.029) and there was no significant difference in postoperative prostate-specific antigen (1.2 ng/mL vs 0.8 ng/mL, p = 0.112). Despite a similar median catheterization time (3 days vs 2 days, p = 0.748), the median hospitalization time was shorter in the HoLEP group (4 days vs 3 days, p = 0.052). Complication rates were similar in both groups (32% vs 36%, p = 0.987).Conclusion: Our results suggest similar outcomes for RASP and HoLEP in patients with very large prostates & GE;200 cc. These findings will require external validation at other high-volume centers

PERI-OPERATIVE OUTCOMES OF OPEN VERSUSROBOT-ASSISTED SIMPLE PROSTATECTOMY: RESULTS FROMTWO HIGH-VOLUME CENTRES

INTRODUCTION AND OBJECTIVE: Simple prostatectomy isthe treatment of choice for symptomatic benign prostatic hyperplasia(BPH), and it should be recommended in prostate glands>80cc.Although functional outcomes of the open approach (OSP) are un-doubtedly favourable, the robotic approach (RASP) is gainingconsensus thanks to its safety and reduced morbidity. However, data ofRASP is scarce, and the majority of published series described smallcohorts with short follow-up. We aimed to investigate perioperativeoutcomes of RASP and OSP in a large cohort of patients from twourological referral centres.METHODS: We analyzed data of 357 consecutive men withsymptomatic BPH who received OSP or RASP at two referral centres[OLV Hospital (Aalst, Belgium) and United Hospitals (Ancona, Italy)]from 2011 to 2021. Multivariable regressions (MVA) investigated vari-ables associated with postoperative complications after adjusting forage, Body Mass Index (BMI), Charlson Comorbidity Index (CCI),prostate volume, concurrent bladder stone or diverticula, indwellingcatheter, surgical approach (OSP vs. RASP), operative time (OT) andestimated blood loss (EBL).RESULTS: A total of 201 (56%) and 156 (44%) men receivedOSP and RASP, respectively. Overall, median (interquartile range[IQR]) age and CCI were 70 (65-76) years and 3 (2-4), with no differ-ences between the groups (both p>0.05). Median [IQR] prostate vol-ume was slightly higher in the RASP vs. OSP group (median: 164 vs.153 cc; p[0.08). As compared to men receiving OSP, OT was longer inthe RASP group (124 vs. 89 minutes), with lower EBL (395 vs. 761 ml),shorter catheterisation time (3 vs. 10 days) and length of stay (LOS) (4vs. 8 days; all medians; all p<0.001). The rate of overall post-operativecomplications was higher in the OSP vs. RASP group (33% vs. 24%;p[0.05), especially of Clavien-Dindo grade 3 (15% vs. 5%;p[0.003), with higher rates of postoperative blood transfusions (28%vs. 1%; p<0.001). On MVA, the probability of postoperativecomplications was higher for older men (odds ratio [OR]: 1.13; 95%confidence interval [CI]: 1.07, 1.23; p[0.047) and for men who hadhigher EBL (OR: 1.45; 95%CI: 1.02, 1.53; p[0.001), whereas theassociation between surgical approach and overall postoperativecomplications was not statistically significant (OR: 0.88; 95% CI 0.64,1.27; p[0.1).CONCLUSIONS: As compared to OSP, RASP allows for lowerpostoperative complications and blood transfusions and thus, it mightbe considered an option for the treatment of symptomatic BPH ac-cording to physician's preference