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- 1. Impact of Fluids Intake: Urological perspectives Ahmed S. El Hefnawy, MD Assistant Professor of Urology UNC- Mansoura University
- 2. Impact of fluid intake • Stone formation • Urinary tract infection • Cancer • No for fluids
- 3. Fluids and Stone formation • Hemostatic control of body fluid balance Renal water saving mechanism Plasma osmolarity 285 -295 mOsm/kg
- 4. Decrease fluid volume TRPV Arginin Vasopressin Increase water reabsorption Decrease urine volume and increase osmolarity
- 5. Current recommendations of total fluid intake • Varies between countries and organizations European Food Safety Agency 2.5 Liters 2 Liters 20% coming from Food
- 6. Current recommendations of total fluid intake • Varies between countries and organizations Germay –Austria-Swutzerland joint nutrition guidelines 2 L 1.6 L Not based on clear health rationale NO data from RCTs
- 7. Fluid intake and Stone formation • Epidemiology • Highly prevalent world wide • North America 7—13% • Middle East 20%
- 9. Fluid intake and Stone formation Factors favor stone formation: • Lower volume of water • Low citrate level • Increase in solutes e.g. Ca, oxalate, uric acid and phosphate
- 10. Effect of supersaturation Normal human urine Ca Ox Concentation is 4 times its sulibilty in water In supersatureated urine : 11 times its sulubility Fluid intake and Stone formation
- 11. Dietary factors • Excess intake of animal protein, dietary sodium , refined sugars and food rich in oxalate Obesity Increase excretion of calcium , Oxalate and uric acid Low pH through insulin resistance , along with DM…….>Uric acid stones Fluid intake and Stone formation
- 12. 15 studies 351,081 participant Each 500 ml…reduced risk (RR= 0.93; 95% CI:0.87, 0.98; P< 0.01)
- 14. Hyper calciuria •Ca restriction is not recommended •Diets with ca content >1gm/day and low protein low sodium could be protective Hperoxaluria •Low oxalat and normal to high calcium REDUCE urinary excretion •Intake of pyridoxine reduce excretion Liberal fluid intake
- 15. II. Urinary Tract Infection • Frequency of UTI is 50 times higher in adult women than men Estimated global incidence is at least 250 m/y. Accurate estimation is difficult outpatient basis. based on symptomatology Most common E coli 70-90% Staphylococcus saprophyticus
- 16. Impact of high fluid intake • Diluting effect • Flushing effect and washing out • Shrinking effect and reducing available surface area • Maintenance of optimum urine pH II. Urinary Tract Infection
- 17. Non randomized multivariate analysis 791 women teachers Deliberately restrict fluid Void once or not at all Drink without restriction Higher risk : RR 2.21, 95% CI 1.45-3.38 II. Urinary Tract Infection
- 18. III. Bladder cancer • Forth most common in men • Exposure to carcinogens e.g. aromatic amines • High fluid intake may play a role in protection?? • Logical thinking • No consensus has yet emerged
- 19. • Dietary intervention • Low fruit: RR= 1.4 • low vegetable: RR= 1.16 • high fat intake :RR=1.37 Individual dietary constituents reduce risk IS STILL unknown III. Bladder cancer
- 20. No for fluids
- 21. Over active bladder Syndrome • Urgency • Frequency • Nocturia • Urge incontinence
- 24. Rationale for this meeting • Does fasting have negative impact? • Are we now in position to be defenders or instructors?