SCREENING FOR NEPHRO-UROLOGICAL DISEASES AMONG AIRCREW MEMBERS

INTRODUCTION: Nephro-urological diseases are for the flying surgeon a frequent and important challenge in the fitness assessment process. Thus, the risk of inflight incapacitation in case of renal colic for overseas deployed fighter pilot, the risk of recurrence of previously treated calculi and its prevention are highly significant facts. However, at AMC the fitness assessment process is not only retrospective. Moreover, physical examination and urinalysis, as done at each visit, remain the cornerstone of the screening evaluation for nephrourological diseases. METHODS: retrospective study (1997-2007) of the medical files of the aircrew members (AM) admitted in the Department of Aerospace Medicine (HIA PERCY) for urolithiasis. RESULTS: Fifty seven AM of the French Air Forces were admitted [males, mean age: 33,3 yo, 1 5 heli pilot (P), 15 flight engineer, 10 ATC, 9 transport P, 8 fighter P]. Microspic hematuria (confirmed by usual methods) in asymptomatic AM was present in 8 AM; 1 had urinary infection, 1 AM had macroscopic hematuria, renal calculi was fortuitously discovered at imaging (performed for another cause) in 7 AM and 40 AM (70%) had renal colic (1 in-flight, 3 during deployment). Echography and CT scan confirmed lithiasis in all. After treatment [extracorporeal shock wave lithotripsy (ESWL) for 30, ureteroscopy (URS) for 12], 34 AM remain "stone-free". Recurrence occurred among 23 AM (40 events): only 3 AM had renal colic, 37 recurrences were discovered during the follow-up by Low Dose CT Scan (asymptomatic +/- microscopic hematuria). DISCUSSION: Urinary tract calculi is the most frequent and important cause of nephro-urological disease among AM. At the AMC, physical examination and urinanalysis aremandatory and useful for the aeromedical expert. Furthermore, other nephro-urological diseases may also be discovered (glomerulonephritis, polycystic kidney disease and elevated blood pressure...). These situations emphazise the role of clinical aviation medicine.