Diphallia with a normal and a blind-ending urethra

Regional short-term climate variations influence on the number of visits for renal colic in a large urban Emergency Department: results of a 7-year survey

The pathogenesis of renal stones is an intricate process and varies widely depending on the composition of stones. There is also a marked geographic variability, strongly attributable to the mean annual temperature (MAT) and, to a lesser extent, on the seasons. Previous investigations report peaks in Emergency Department (ED) visits for renal colic during the summer. The aim of the present investigation is to assess the influence of day-by-day climate changes on the number of visits due to renal colic in our ED (city of Parma, located in the Po river valley, with a temperate continental climate). A total of 8,168 colic episodes were retrieved from our database during a period of 2,557 days (from 1 January 2002 to 31 December 2008). Over the same period 557,990 patients were admitted to our ED, renal colic visits representing 1.46% of the total. The linear regression analysis fitting the mean number of colic visits per day and the mean daily temperature displays a very high and significant correlation (R = 0.88, p < 0.0001). A multiple linear regression analysis between the mean temperature of each of the 30 days preceding the colic episode also shows strong correlations, being the strongest on the 5th-7th days (R = 0.80, p < 0.0001 on the 6th day before the colic episode), and a weaker but highly significant correlation on days 14 (R = 0.77, p < 0.0001) and 20 (R = 0.70, p < 0.0001) before the colic episode. Taken together, these findings suggest a kind of "acceleration" process of stone formation caused by the hot climate and, perhaps, by dietary variations during the summer. This process might trigger a sudden growth of the stone and, finally, the resulting clinical episode.

Do weather conditions influence the onset of renal colic? A novel approach to analysis

BACKGROUND/AIM

To investigate the seasonal variations of the incidence of renal colic by a computerized analysis of cyclic climatic features.

METHODS

1,163 consecutive patients with acute renal colic were studied. Eigendecomposition and signal reconstruction of district temperature and humidity were performed to establish any cyclic variation. Average temperatures and humidity values were calculated at time periods of 15, 30, 45 and 60 days preceding each renal colic.

RESULTS

Patients were allocated to groups every 30 days, since eigendeanalysis suggested that intervals of this duration have homogeneous climatic features. With an average time period of 15 days preceding each renal colic, a positive correlation coefficient of temperature (r = +0.75 with CI 0.31-0.93, p < 0.005) and a cubic relationship at the regression analysis (R = 82.4%, p = 0.015) were found with the onset of colics. We observed a negative correlation between humidity and renal colic (rho = -0.70 with CI -0.92 to -0.21, p < 0.01), with an inverse relation as regression model (R = 57.9%, p < 0.05).

CONCLUSIONS

We demonstrated an association between the onset of renal colics and exposure to hot and dry weather, particularly when temperatures rose above 27 degrees C and relative humidity fell below 45%.

Duplication of the glans penis manifested at puberty

We report the case of a complete duplication of the glans, with prepuce and a blind end urethra just proximal to the dorsal aspect of the balanopreputial fold. The malformation was not evident at birth and during childhood, and became manifest only at puberty, with the growth of the external genitalia. It was not associated with other urinary malformations. Surgical excision was easy and uneventful.

Clinical and embryologic aspects of penile duplication and associated anomalies

OBJECTIVES

To report 2 cases of penile duplication and review the literature in an attempt to categorize the associated anomalies in relation to the degree of penile duplication. Embryologic considerations of this rare anomaly are also reviewed.

METHODS

We report 2 distinct cases of diphallia. In the first case, true complete penile duplication was associated with multiple malformations, including a cloacal anomaly, colon and bladder duplication, a horseshoe kidney, a bifid scrotum with undescended testes, a hypoplastic right leg, and a ventricular septum defect. The second patient presented with true, complete diphallia and bladder and urethral duplication but an absence of other anomalies. The patients were individually treated according to the concomitant malformations. A review of published reports allowed a classification of associated anomalies in 77 cases of diphallia, according to the degree of penile duplication.

RESULTS

The first patient underwent a series of staged surgical repairs, including correction of the congenital heart anomaly, separation of the urogenital and gastrointestinal tract and resection of the duplicate terminal colon, excision of the smaller bladder and underdeveloped duplicate penis, bilateral orchiopexy, and hypospadias correction. The second patient underwent bladder fusion and excision of a urethrorectal fistula. Penile reconstruction was left for a later stage. An analysis of the cases available in published studies suggests that diphallia is often associated with a wide spectrum of anomalies that vary from severe malformations to less significant variations of human anatomy.

CONCLUSIONS

Penile duplication is a rare anomaly. Thorough investigations are mandatory in all cases to reveal underlying congenital malformations that are potentially life threatening and require immediate surgical correction. Treatment should always be individualized according to the degree of penile duplication and the extent of the concomitant anomalies.

Seasonal variation in urinary excretion of calcium, oxalate, magnesium and phosphate on free and standard mineral diet in men with urolithiasis

Seasonal variations of urine volume and urinary excretion of calcium, oxalate, magnesium and phosphate were studied in 118 men with urolithiasis on a standard mineral diet and on free diet. The 24-hour urine volume did not vary by season. There was no significant seasonal variation in the excretion of urinary calcium, oxalate, magnesium or phosphate on a standard mineral diet. While on a free diet the patients' urinary excretion of calcium showed statistically significant seasonal differences between age groups. The seasonal variations in the excretion of urinary oxalate and phosphate were statistically significant on free diet, but did not differ by age. The urinary excretion of magnesium was not affected by season nor age. Dietary intake probably best explains seasonal changes in the urinary excretion of calcium, oxalate and phosphate.

Renal stone disease in a Swedish district during one year

In a Swedish district served by only one hospital the annual incidence of urinary stone colic was estimated to 1.4 per 1000 inhabitants. Sixty-two per cent of the patients were treated entirely as out patients whereas 9% required some form of surgery during the study. Thirty-seven per cent of the patients were recurrent stone formers. No significant seasonal variation in stone incidence was noted. A definite reason for stone formation could be established in 6%, and among 56 patients with recurrent stone disease run through a biochemical investigation, abnormal findings were recorded in 70%.