Urinary retention associated with herpes zoster infection.

PubMed

Cohen, L M; Fowler, J F; Owen, L G; Callen, J P

1993-01-01

Herpes zoster infection particularly involving the sacral dermatomes has been associated with bladder and bowel dysfunction, most commonly urinary retention. We report two patients who developed acute urinary retention, one of whom also had constipation, within days of herpes zoster skin lesions of the S2-S4 dermatomes. Herpes zoster is a reversible cause of neurogenic bladder and bowel dysfunction and should be considered in a patient that presents with acute urinary retention and/or constipation. Sensory abnormalities and flaccid detrusor paralysis are most likely involved in the pathogenesis.

Acute urinary retention attributable to sacral herpes zoster.

PubMed

Acheson, J; Mudd, D

2004-11-01

Acute urinary retention in women is uncommon. A 63 year old woman presented with suprapubic pain, a palpable bladder, and multiple grouped vesicles on the right buttock. Catheterisation showed a residual of 2000 ml. A case is reported of acute urinary retention secondary to herpes zoster infection of the sacral nerves (S2-4).

Cystocele (Prolapsed Bladder)

MedlinePlus

... Prostate Enlargement (Benign Prostatic Hyperplasia) Urinary Diversion Urinary Retention Urine Blockage in Newborns Vesicoureteral Reflux (VUR) The ... laughing, or physical activity, such as walking. Urinary retention —the inability to empty the bladder completely—may ...

Conceptual and Operational Definitions for the Nursing Diagnosis "Urinary Retention".

PubMed

Costa, Juliana Neves da; Botelho, Micnéias Lacerda; Duran, Erika Christianne Marocco; Carmona, Elenice Valentim; Oliveira-Kumakura, Ana Railka de Souza; Lopes, Maria Helena Baena de Moraes

2017-12-07

To develop conceptual and operational definitions for defining characteristics and related factors for nursing diagnosis of urinary retention, as contained in Taxonomy II of NANDA-I. Integrative literature review and elaboration of terms related to urinary retention. It includes operational and conceptual definitions of the nursing diagnosis urinary retention. It is necessary to review the definition of this nursing diagnosis and most of its defining characteristics and related factors. The use of internationally known terms for various disciplines in areas of common knowledge helps to standardize the language used by professionals. © 2017 NANDA International, Inc.

Sacral neurostimulation for urinary retention: 10-year experience from one UK centre.

PubMed

Datta, Soumendra N; Chaliha, Charlotte; Singh, Anubha; Gonzales, Gwen; Mishra, Vibhash C; Kavia, Rajesh B C; Kitchen, Neil; Fowler, Clare J; Elneil, Sohier

2008-01-01

To report our 10-year experience of sacral neurostimulation (SNS) for women in urinary retention, comparing the original one-stage with the newer two-stage technique, as SNS therapy is a well-established treatment for urinary retention secondary to urethral sphincter overactivity (Fowler's syndrome). Between 1996 and 2006, 60 patients with urinary retention had a SNS device inserted; their case records were reviewed and data on efficacy, follow-up, need for continued clean intermittent self-catheterization (CISC), complications and operative revision rate were assessed. Overall, 43 of 60 (72%) women were voiding spontaneously, with a mean postvoid residual volume of 100 mL; 30 (50%) no longer needed to use CISC. During a total of 2878 months of SNS experience, adverse event episodes included lead migration in 20, 'box-site' pain in 19, leg pain/numbness in 18 and loss of response/failure in 18 patients; 53% of the women required a surgical revision related to their implanted stimulator. The efficacy of the two-stage was similar to that of the one-stage procedure (73% vs 70%). Women with a normal urethral sphincter electromyogram had worse outcomes than women with an abnormal test (43% vs 76%). Although the efficacy was no different in those taking analgesia/antidepressant medication, this group of women had a higher surgical revision rate. Failure and complications for the one-stage procedure were not restricted to the early follow-up period. The mean battery life of the implant was 7.31 years. SNS has sustained long-term efficacy but the procedure has a significant complication rate. At present, the two-stage technique has comparable efficacy to the one-stage technique but a longer-term follow-up is required. The National Institute of Clinical Excellence recommended the use of SNS in women with urinary incontinence who fail to respond adequately to anticholinergic therapy, but patients choosing this treatment should be made aware of the high complication rate associated with the procedure.

Transdermal Scopolamine and Acute Postoperative Urinary Retention in Pelvic Reconstructive Surgery.

PubMed

Propst, Katie; OʼSullivan, David M; Tulikangas, Paul K

2016-01-01

To evaluate the relationship between perioperative use of transdermal scopolamine and the rate of urinary retention after stress urinary incontinence and pelvic organ prolapse procedures in women. This is a retrospective, cohort study; the primary outcome is the rate of acute postoperative urinary retention. Study candidates were adult female patients who underwent pelvic reconstructive surgery at a tertiary care center. Subjects were excluded if preoperative postvoid residual urine volume was greater than 150 mL, preoperative urodynamic testing was not performed, or if a postoperative trial of void was not performed. Subjects were grouped based on preoperative use of transdermal scopolamine. Patients were selected consecutively until 138 subjects per group was reached. Differences in rates of acute postoperative urinary retention were evaluated using a chi-square test. Group demographics were evaluated using t tests and χ tests. Two hundred seventy-six subjects were included in the analysis, 138 received a transdermal scopolamine patch in the perioperative period and 138 did not. The overall rate of acute postoperative urinary retention was 25.3%. There was no significant difference in the rate of acute postoperative urinary retention between the study groups (scopolamine, 26.8%; no scopolamine, 23.9%; P = 0.580). Demographics of the 2 groups were compared; patients who received scopolamine patch were younger (P = 0.001), received a greater amount of intravenous fluids (P = 0.007), and underwent a greater percentage of incontinence procedures (P = 0.048). Otherwise, there were no differences between the groups. Transdermal scopolamine is not a risk factor for acute postoperative urinary retention after pelvic reconstructive procedures.

Herpes zoster infection: a rare cause of acute urinary retention.

PubMed

Chan, Jonathan E; Kapoor, Anil

2003-06-01

Herpes zoster (HZ) infection has been reported as a rare cause of acute urinary retention. HZ infection involving sacral, thoracolumbar, and rarely high thoracic dermatomes is believed to occasionally cause motor and sensory neuropathy of the bladder. This is specifically achieved by the interruption of the detrusor reflex causing subsequent bladder atonia. As the course and management of this entity is quite benign, HZ should remain a diagnostic consideration in the management of urinary retention. We report a case of acute urinary retention of approximately 2.5 liters associated with HZ infection and review the proposed pathogenesis and therapeutic considerations in the management of this entity.

Urinary retention in female OAB after intravesical Botox injection: who is really at risk?

PubMed

Miotla, Pawel; Cartwright, Rufus; Skorupska, Katarzyna; Bogusiewicz, Michal; Markut-Miotla, Ewa; Futyma, Konrad; Rechberger, Tomasz

2017-06-01

Intravesical onabotulinumtoxinA (Botox) injections are effective for the treatment of idiopathic overactive bladder (OAB) symptoms. The aim of our study was to assess the predisposing factors for urinary retention in women with OAB after intravesical Botox injection. All participants were women of European descent with idiopathic OAB. OnabotulinumtoxinA (100 U) was administered in 20 intra-detrusor injections. Analysis was performed based on the results of safety assessments made during follow-up (FU) visits on weeks 2, 4 and 12, in 208 women who were treated with Botox injections for refractory OAB and who completed all FU visits. Women who required clean intermittent self-catheterisation (CISC) and those with post-void residual (PVR) greater than 200 ml were older in comparison with patients with PVR between 50 and 200 ml. Patients who required CISC were also characterised by higher parity and particularly by a higher number of vaginal deliveries. Other factors such as body mass index or comorbidities did not significantly influence PVR and the risk of CISC. Elderly and/or multiparous women are at increased risk of urinary retention after intravesical 100-U Botox injections. The risk of new onset urine retention in our study has completely disappeared 2 weeks after Botox injections. Based on our results of the way in which the PVRs have changed over time, we can conclude that OAB patients should be optimally assessed during the first 2 weeks after Botox injections.

The possible role of opiates in women with chronic urinary retention: observations from a prospective clinical study.

PubMed

Panicker, Jalesh N; Game, Xavier; Khan, Shahid; Kessler, Thomas M; Gonzales, Gwen; Elneil, Sohier; Fowler, Clare J

2012-08-01

Urinary retention in women often presents a diagnostic difficulty, and the etiology may remain unidentified even after excluding structural and neurological causes. We evaluated a group of women referred to a specialist center with unexplained urinary retention. A total of 61 consecutive women with complete urinary retention were evaluated. Urological and neurological investigations locally had failed to identify a cause. Urethral pressure profile, sphincter volume measurement and in some cases urethral sphincter electromyography were performed to diagnose a primary disorder of sphincter relaxation (Fowler's syndrome). Mean patient age was 39 years (range 18 to 88). Following investigations, a probable etiology was identified in 25 (41%) women, the most common being Fowler's syndrome. Of the women 24 (39%) were being treated with opiates for various pain syndromes and in 13 no other cause of retention was identified. Opiates could be discontinued in only 2 patients, and both demonstrated improved sensations and voiding. The cause of urinary retention may remain unknown in spite of extensive investigations. Young women regularly using prescription opiates for various undiagnosed pain syndromes present a challenging clinical problem and this study suggests that iatrogenic causes should be considered if voiding difficulties emerge. An association between opiate use and constipation is well-known and, although urinary retention is a listed adverse event, it appears to be often overlooked in clinical practice. It is hypothesized that Fowler's syndrome is due to an up-regulation of spinal cord enkephalins and that exogenous opiates may compound any functional abnormalities predisposing young women to urinary retention. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Percutaneous nerve evaluation (PNE) for treatment of non-obstructive urinary retention: urodynamic changes, placebo effects, and response rates.

PubMed

Sharifiaghdas, Farzaneh; Mirzaei, Mahboubeh; Ahadi, Babak

2014-03-04

To evaluate the results of percutaneous nerve evaluation (PNE) implantation in the treatment of non-obstructive urinary retention and report the changes in the urodynamic parameters. Patients with non-obstructive urinary retention or incomplete bladder emptying were included. All patients filled a 7 days voiding diary chart and underwent PNE for one week, and the patient was asked to record the second voiding diary chart and repeat urodynamic study in this period. Then the PNE lead was removed from the S3 foramen, but the connections remained fixed in place for another 3 days to exclude the placebo effects and the third voiding diary chart was completed by the patient. The patient wasn't aware of lead removal. Success was defined as, more than 50% improvement in at least one of the urinary tract symptoms. Forty five patients with a mean age of 37.1 years (ranged 9-83 years) were treated with PNE for refractory, non-obstructive urinary retention. Of study subjects 28 complained from complete urinary retention, and 17 had incomplete emptying. Of participants, 28 (62.2%) demonstrated greater than 50% improvement in the urinary symptoms. Urodynamic data, showed a statistically significant increase in maximum flow rate (8 ± 2.2 mL/sec to 16 ± 3.6 mL/sec, P = .06) and voided volume (35 mL to 187 mL, P = .032) in the responders. Any placebo effects in PNE have not been seen. Patients with complete non obstructive urinary retention were good responders to PNE. The placebo effect in sacral nerve stimulation was negligible.

Sonographic findings in acute urinary retention secondary to retroverted gravid uterus: pathophysiology and preventive measures.

PubMed

Yang, J-M; Huang, W-C

2004-05-01

To explore the pathophysiology of acute urinary retention in women with a retroverted gravid uterus and to suggest measures to prevent its recurrence. In five women with a retroverted gravid uterus and acute urinary retention necessitating catheterization, the morphology of the genitourinary system was assessed by using transabdominal, transvaginal and introital sonography. In the supine resting position, the cervix was displaced superiorly and anteriorly by the impacted and retroverted uterus so that it compressed the lower bladder, leading to obstruction of the internal urethral orifice. The upper bladder extended superiorly and overlay the uterus. During straining, urethral motion was not limited and there was an average rotational angle of the bladder neck of 32 degrees, ranging from 21 degrees to 44 degrees. Increasing abdominal pressure further compressed the lower bladder. Measures suggested to the women for the prevention of urinary retention included limiting fluid intake before sleep, changing from the supine to the prone position before getting up and avoiding a Valsalva maneuver but performing a Credé maneuver during voiding. In all except one case these measures successfully prevented recurrence. Acute urinary retention secondary to a retroverted gravid uterus is caused by a displaced cervix compressing the lower bladder and interfering with drainage to the urethra. The urethra itself is not compressed or distorted. Understanding the pathophysiology of the lower urinary tract may allow maneuvers which prevent acute urinary retention. Copyright 2004 ISUOG. Published by John Wiley & Sons, Ltd.

Acute urinary retention in a pre-school girl with constipation

PubMed Central

Traslaviña, Guillermo A. Ariza; Ciampo, Luiz Antonio Del; Ferraz, Ivan Savioli

2015-01-01

Objective: To report a case of a preschool girl who developed acute urinary retention associated with constipation. Case description: A girl aged six years old presented a 24 h history of inability to urinate. She was went twice to the emergency room during this period. In the first admission, 12 h after the onset of the symptoms, she presented abdominal pain and acute urinary retention. After the drainage by urinary catheterization of 300 mL of clear urine, she presented relief of the symptoms and, as urinalysis had no change, the patient was discharged home. Twelve hours after the first visit, she returned to the emergency room complaining about the same symptoms. At physical examination, there was only a palpable and distended bladder up to the umbilicus with no other abnormalities. Again, a urinary catheterization was performed, which drained 450 mL of clear urine, with immediate relief of the symptoms. Urinalysis and urine culture had no abnormalities. During the anamnesis, the diagnosis of constipation was considered and a plain abdominal radiography was performed, which identified large amount of feces throughout the colon (fecal retention). An enema with a 12% glycerin solution was prescribed for three days. During follow-up, the child used laxatives and dietary modifications, this contributed to the resolution of the constipation. There were no other episodes of urinary retention after 6 months of follow-up. Comments: Acute urinary retention in children is a rare phenomenon and constipation should be considered as a cause. PMID:26298658

Acute urinary retention due to benign inflammatory nervous diseases.

PubMed

Sakakibara, Ryuji; Yamanishi, Tomonori; Uchiyama, Tomoyuki; Hattori, Takamichi

2006-08-01

Both neurologists and urologists might encounter patients with acute urinary retention due to benign inflammatory nervous diseases. Based on the mechanism of urinary retention, these disorders can be divided into two subgroups: disorders of the peripheral nervous system (e.g., sacral herpes) or the central nervous system (e.g., meningitis-retention syndrome [MRS]). Laboratory abnormalities include increased herpes virus titers in sacral herpes, and increased myelin basic protein in the cerebrospinal fluid (CSF) in some cases with MRS. Urodynamic abnormality in both conditions is detrusor areflexia; the putative mechanism of it is direct involvement of the pelvic nerves in sacral herpes; and acute spinal shock in MRS. There are few cases with CSF abnormality alone. Although these cases have a benign course, management of the acute urinary retention is necessary to avoid bladder injury due to overdistension. Clinical features of sacral herpes or MRS differ markedly from those of the original "Elsberg syndrome" cases.

Sacral Nerve Stimulation For Urinary Urge Incontinence, Urgency-Frequency, Urinary Retention, and Fecal Incontinence

PubMed Central

2005-01-01

Executive Summary Objective The aim of this review was to assess the effectiveness, safety, and cost of sacral nerve stimulation (SNS) to treat urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence. Background: Condition and Target Population Urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence are prevalent, yet rarely discussed, conditions. They are rarely discussed because patients may be uncomfortable disclosing their symptoms to a health professional or may be unaware that there are treatment options for these conditions. Briefly, urge incontinence is an involuntary loss of urine upon a sudden urge. Urgency-frequency is an uncontrollable urge to void, which results in frequent, small-volume voids. People with urgency-frequency may or may not also experience chronic pelvic pain. Urinary retention refers to the inability to void despite having the urge to void. It can be caused by a hypocontractile detrusor (weak or no bladder muscle contraction) or obstruction due to urethral overactivity. Fecal incontinence is a loss of voluntary bowel control. The prevalence of urge incontinence, urgency-frequency, and urinary retention in the general population is 3.3% to 8.2%, and the prevalence of fecal incontinence is 1.4% to 1.9%. About three-quarters of these people will be successfully treated by behaviour and/or drug therapy. For those who do not respond to these therapies, the options for treatment are management with diapers or pads, or surgery. The surgical procedures are generally quite invasive, permanent, and are associated with complications. Pads and/or diapers are used throughout the course of treatment as different therapies are tried. Patients who respond successfully to treatment may still require pads or diapers, but to a lesser extent. The Technology Being Reviewed: Sacral Nerve Stimulation Sacral nerve stimulation is a procedure where a small device attached to an electrode is implanted in the abdomen or buttock to stimulate the sacral nerves in an attempt to manage urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence. The device was originally developed to manage urinary urge incontinence; however, it has also been used in patients with urgency-frequency, urinary retention, and fecal incontinence. SNS is intended for patients who are refractory to behaviour, drug, and/or interventional therapy. There are 2 phases in the SNS process: first, patients must undergo a test stimulation phase to determine if they respond to sacral nerve stimulation. If there is a 50% or greater improvement in voiding function, then the patient is considered a candidate for the next phase, implantation. Review Strategy The standard Medical Advisory Secretariat search strategy was used to locate international health technology assessments and English-language journal articles published from 2000 to November 2004. The Medical Advisory Secretariat also conducted Internet searches of Medscape (1) and the manufacturer’s website (2) to identify product information and recent reports on trials that were unpublished but that were presented at international conferences. In addition, the Web site Current Controlled Trials (3) was searched for ongoing randomized controlled trials (RCTs) investigating the role of sacral nerve stimulation in the management of voiding conditions. Summary of Findings Four health technology assessments were found that reviewed SNS in patients with urge incontinence, urgency-frequency, and/or urinary retention. One assessment was found that reviewed SNS in patients with fecal incontinence. The assessments consistently reported that SNS was an effective technology in managing these voiding conditions in patients who did not respond to drug or behaviour therapy. They also reported that there was a substantial complication profile associated with SNS. Complication rates ranged from 33% to 50%. However, none of the assessments reported that they found any incidences of permanent injury or death associated with the device. The health technology assessments for urge incontinence, urgency-frequency, and urinary retention included (RCTs (level 2) as their primary source of evidence for their conclusions. The assessment of fecal incontinence based its conclusions on evidence from case series (level 4). Because there was level 2 data available for the use of SNS in patients with urinary conditions, the Medical Advisory Secretariat chose to review thoroughly the RCTs included in the assessments and search for publications since the assessments were released. However, for the health technology assessment for fecal incontinence, which contained only level 4 evidence, the Medical Advisory Secretariat searched for studies on SNS and fecal incontinence that were published since that assessment was released. Urge Incontinence Two RCTs were identified that compared SNS to no treatment in patients with refractory urge incontinence. Both RCTs reported significant improvements (> 50% improvement in voiding function) in the SNS group for number of incontinence episodes per day, number of pads used per day, and severity of incontinence episodes. Urgency-Frequency (With or Without Chronic Pelvic Pain) One RCT was identified that compared SNS to no treatment in patients with refractory urgency-frequency. The RCT reported significant improvements in urgency-frequency symptoms in the SNS group (average volume per void, detrusor pressure). In addition to the RCT, 1 retrospective review and 2 prospective case series were identified that measured pelvic pain associated with urgency-frequency in patients who underwent SNS. All 3 studies reported a significant decrease in pain at median follow-up. Urinary Retention One RCT was identified that compared SNS to no treatment in patients with refractory urinary retention. The RCT reported significant improvements in urinary retention in the SNS group compared to the control group for number of catheterizations required and number of voids per day. In addition to this RCT, 1 case series was also identified investigating SNS in women with urinary retention. This study also found that there were significant improvements in urinary retention after the women had received the SNS implants. Fecal Incontinence Three case series were identified that investigated the role of SNS in patients with fecal incontinence. All 3 reported significant improvements in fecal incontinence symptoms (number of incontinent episodes per week) after the patients received the SNS implants. Long-Term Follow-up None of the studies identified followed patients until the point of battery failure. Of the 6 studies identified describing the long-term follow-up of patients with SNS, follow-up periods ranged from 1.5 years to over 5 years. None of the long-term follow-up studies included patients with fecal incontinence. All of the studies reported that most of the patients who had SNS had at least a 50% improvement in voiding function (range 58%–77%). These studies also reported the number of patients who had their device explanted in the follow-up period. The rates of explantation ranged from 12% to 21%. Safety, Complications, and Quality of Life A 33% surgical revision rate was reported in an analysis of the safety of 3 RCTs comparing SNS to no treatment in patients with urge incontinence, urgency-frequency, or urinary retention. The most commonly reported adverse effects were pain at the implant site and lead migration. Despite the high rate of surgical revision, there were no reports of permanent injury or death in any of the studies or health technology assessments identified. Additionally, patients consistently said that they would recommend the procedure to a friend or family member. Economic Analysis One health technology assessment and 1 abstract were found that investigated the costing factors pertinent to SNS. The authors of this assessment did their own “indicative analysis” and found that SNS was not more cost-effective than using incontinence supplies. However, the assessment did not account for quality of life. Conversely, the authors of the abstract found that SNS was more cost-effective than incontinence supplies alone; however, they noted that in the first year after SNS, it is much more expensive than only incontinence supplies. This is owing to the cost of the procedure, and the adjustments required to make the device most effective. They also noted the positive effects that SNS had on quality of life. Conclusions and Implications In summary, there is level 2 evidence to support the effectiveness of SNS to treat people with urge incontinence, urgency-frequency, or urinary retention. There is level 4 evidence to support the effectiveness of SNS to treat people with fecal incontinence. To qualify for SNS, people must meet the following criteria: Be refractory to behaviour and/or drug therapy Have had a successful test stimulation before implantation; successful test stimulation is defined by a 50% or greater improvement in voiding function based on the results of a voiding diary. Test stimulation periods range from 3 to 7 days for patients with urinary dysfunctions, and from 2 to 3 weeks for patients with fecal incontinence. Be able to record voiding diary data, so that clinical results of the implantation can be evaluated. Patients with stress incontinence, urinary retention due to obstruction and neurogenic conditions (such as diabetes with peripheral nerve involvement) are ineligible for sacral nerve stimulation. Physicians will need to learn how to use the InterStim System for Urinary Control. Requirements for training include these: Physicians must be experienced in the diagnosis and treatment of lower urinary tract disorders and should be trained in the implantation and use of the InterStim System for Urinary Control. Training should include the following: Participation in a seminar or workshop that includes instructional and laboratory training on SNS. This seminar should include a review of the evidence on SNS with emphasis on techniques to prevent adverse events. Completion of proctoring by a physician experienced in SNS for the first 2 test stimulations and the first 2 implants PMID:23074472

Eosinophilic cystitis with recurrent urinary retention: case report.

PubMed

Park, Hongzoo

2017-01-01

Eosinophilic cystitis is a rare inflammatory disease of the bladder whose origin, pathogenesis, and treatment are unknown. Frequency, dysuria, and hematuria are frequent symptoms. Here, we report a rare occurrence of recurrent urinary retention and repetitive catheterization. A 67-year-old male presented with acute urinary retention and intermittent gross hematuria of 2 weeks duration. Urethral catheterization followed by a trial without catheter, was successful. Complete blood count showed presence of eosinophils (eosinophilia) and computed tomography of kidneys, ureter and bladder with contrast showed thickened bladder wall and small prostate. Cystoscopy revealed an erythematous lesion over the anterior wall. The rest of the mucosa was normal. Transurethral biopsies of the lesion were performed and histologic examination showed features of eosinophilic cystitis. Despite multiple medication regimens containing corticosteroids and antihistamines, he presented with recurrent urinary retention, approximately once every month. After 6 months, he was started on bethanechol, which led to no catheterization for up to 2 years. To the best of our knowledge, this is the first report on the successful use of bethanechol as a treatment for eosinophilic cystitis with recurrent urinary retention.

Herpes zoster-associated acute urinary retention in immunocompetent patient*

PubMed Central

Marques, Silvio Alencar; Hortense, Juliana

2014-01-01

Herpes zoster-associated urinary retention is an uncommon event related to virus infection of the S2-S4 dermatome. The possible major reasons are ipsilateral hemicystitis, neuritis-induced or myelitis-associated virus infection. We report a case of a 65-year-old immunocompetent female patient who presented an acute urinary retention after four days under treatment with valacyclovir for gluteal herpes zoster. The patient had to use a vesical catheter, was treated with antibiotics and corticosteroids and fully recovered after eight weeks. PMID:25387508

Acute urinary retention secondary to a urethral calculus in a bladder-drained kidney pancreas transplant patient - a metallic clip nidus.

PubMed

Smith, J B K; Sairam, K; Olsburgh, J

2009-01-01

Urological expertise is usually required for the management of any urological complications of bladder-drained pancreatic allografts whether they are the result of simultaneous pancreas-kidney transplants, pancreas after kidney transplants, or pancreas transplants alone. This study presents a case of urinary retention secondary to prostatic urethra calculus impaction, the nidus of which was found to be metallic staples from the donor duodenal segment of a pancreatic allograft. Knowledge of the pre-transplant benchwork gave a high index of suspicion to the urological sequelae of this case and, in particular, the presence of calculi should suggest a metal clip nidus. We examine the methods of exocrine pancreatic drainage, donor duodenum preparation and case management.

Urinary Retention

MedlinePlus

... urinary retention with • bladder drainage • urethral dilation • urethral stents • prostate medications • surgery The type and length of ... patient will receive sedation and regional anesthesia. Urethral Stents Another treatment for urethral stricture involves inserting an ...

Transient urinary retention and chronic neuropathic pain associated with genital herpes simplex virus infection.

PubMed

Haanpää, Maija; Paavonen, Jorma

2004-10-01

Genital herpes (GH) causes genital ulcer disease, severe transient pain, and often paresthesias. Whether or not GH can cause urinary retention or chronic neuropathic pain is not well known. We present two immunocompetent patients with GH associated with neuropathic symptoms. We also review the literature on GH and associated neurologic problems. Patient 1 had primary herpes simplex virus (HSV)-2 infection with transient urinary retention and chronic bilateral neuropathic pain in the sacral area. Patient 2 had recurrent HSV-1 associated with unitaleral chronic neuropathic pain in the sacral area. Although transient urinary retention associated with GH is not uncommon, chronic neuropathic pain has not been reported previously. Our cases show that chronic neuropathic pain, that is "pain initiated or caused by a primary lesion or dysfunction in the nervous system," can follow genital HSV infection.

Urologic Emergencies.

PubMed

Manjunath, Adarsh S; Hofer, Matthias D

2018-03-01

Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis, whereas imaging is increasingly used to confirm diagnoses. Acute urinary retention should be relieved with Foley placement. Penile emergencies include paraphimosis, which can be treated by foreskin reduction, whereas penile fracture and priapism require urologic intervention. Fournier gangrene and testicular torsion are scrotal emergencies requiring emergent surgery. Nephrolithiasis, although painful, is not an emergency unless there is concern for concomitant urinary tract infection, both ureters are obstructed by stones, or there is an obstructing stone in a solitary kidney. Copyright © 2017 Elsevier Inc. All rights reserved.

Undiagnosed nephrogenic diabetes insipidus as a cause of acute urinary retention in a young soldier.

PubMed

Kim, Hyung Jin; Shin, Y S; Choi, H; Kim, M K; Jeong, Y B; Park, J K

2016-10-01

We present a case of undiagnosed nephrogenic diabetes insipidus as a cause of acute urinary retention in a 21-year-old male soldier. Soldiers live in close quarters, and have a regimented lifestyle that may not allow for frequent voiding; therefore, undiagnosed nephrogenic diabetes insipidus may result in acute urinary retention. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

TVT-Secur mini-sling for stress urinary incontinence: a review of outcomes at 12 months.

PubMed

Walsh, Colin A

2011-09-01

• Synthetic mid-urethral slings (MUSs) are considered the first choice surgical procedure for stress urinary incontinence. Recent publications have raised concerns about the efficacy of third generation single-incision mini-slings. The present paper is a systematic review of studies reporting 12-month outcomes after the TVT-Secur (TVT-S) procedure. • Pubmed/Medline online databases, abstracts from recent International Continence Society and International Urogynecological Association annual scientific meetings and the Clinicaltrials.gov and Controlled-trials.com online trial registries were searched for English-language articles containing the terms 'TVT-Secur', 'TVT Secur' or 'mini-sling'. The primary outcomes were objective and subjective cure rates at 12 months. Secondary outcomes included peri-operative (vaginal perforation, urinary retention, urinary tract infection [UTI]) and postoperative (mesh exposure, de novo overactive bladder (OAB), dyspareunia and return to theatre) complication rates. • Among 1178 women undergoing the TVT-S procedure, from 10 studies, both objective and subjective cure rate at 12 months was 76%, with objective cure significantly higher in women undergoing the 'U-type' approach. Vaginal perforation was a complication in 1.5% of cases, with a 2.4% incidence of mesh exposure in the first year. The incidence of de novo OAB symptoms was 10%. Rates of urinary retention (2.3%), UTI (4.4%), dyspareunia (1%) and return to theatre for complications (0.8%) were low. In the first year after a TVT-S procedure 5% of women required repeat continence surgery. • Longer-term studies and randomized comparisons with more established MUSs are required before TVT-S should be routinely used in the surgical treatment of stress urinary incontinence. © 2011 THE AUTHOR. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

A rapid, maskless 3D prototyping for fabrication of capillary circuits: Toward urinary protein detection.

PubMed

Yan, Sheng; Zhu, Yuanqing; Tang, Shi-Yang; Li, Yuxing; Zhao, Qianbin; Yuan, Dan; Yun, Guolin; Zhang, Jun; Zhang, Shiwu; Li, Weihua

2018-04-01

Proteinuria is an established risk marker for progressive renal function loss and patients would significantly benefit from a point-of-care testing. Although extensive work has been done to develop the microfluidic devices for the detection of urinary protein, they need the complicated operation and bulky peripherals. Here, we present a rapid, maskless 3D prototyping for fabrication of capillary fluidic circuits using laser engraving. The capillary circuits can be fabricated in a short amount of time (<10 min) without the requirements of clean-room facilities and photomasks. The advanced capillary components (e.g., trigger valves, retention valves and retention bursting valves) were fabricated, enabling the sequential liquid delivery and sample-reagent mixing. With the integration of smartphone-based detection platform, the microfluidic device can quantify the urinary protein via a colorimetric analysis. By eliminating the bulky and expensive equipment, this smartphone-based detection platform is portable for on-site quantitative detection. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction.

PubMed

Grünewald, Volker; Höfner, Klaus; Thon, Walter F.; Kuczyk, Markus A.; Jonas, Udo

1999-01-01

Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives.

Risk of urinary retention after nerve-sparing surgery for deep infiltrating endometriosis: A systematic review and meta-analysis.

PubMed

de Resende, José Anacleto Dutra; Cavalini, Luciana Tricai; Crispi, Claudio Peixoto; de Freitas Fonseca, Marlon

2017-01-01

Recently, nerve-sparing (NS) techniques have been incorporated in surgeries for deep infiltrating endometriosis (DIE) to prevent urinary complications. Our aim was to perform a systematic review and meta-analysis to assess the risk of urinary retention after NS surgery for DIE compared with classical (non-NS) techniques. Following the MOOSE guidelines for systematic reviews of observational studies, data were collected from published research articles that compared NS techniques with non-NS techniques in DIE surgery, with regard to post-operative urinary complications. randomized clinical trials, intervention or observational (cohort and case-control) studies assessing women who underwent surgery for painful DIE. cancer surgery and women submitted to bladder or ureteral resections. The respective relative risks (RR) and 95% confidence intervals (CI) were extracted and a forest plot was generated to show individual and combined estimates. Preliminarily, 1,270 potentially relevant studies were identified from which four studies were selected. A meta-analysis was performed to assess the risk of urinary retention at discharge and 90 days after surgery. We found a common RR of 0.19 [95%CI: 0.03-1.17; (I 2  = 50.20%; P = 0.09)] for need of self-catheterization at discharge in the NS group in relation to the conventional technique. Based on two studies, common RR for persistent urinary retention (after 90 days) was 0.16 [95%CI: 0.03-0.84]. Our results suggest significant advantages of the NS technique when considering the RR of persistent urinary retention. Controlled studies evaluating the best approach to manage the urinary tract after complex surgery for DIE are needed. Neurourol. Urodynam. 36:57-61, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Pubic Bone Osteomyelitis after Salvage High-Intensity Focused Ultrasound for Prostate Cancer

PubMed Central

Robison, Christopher M.; Gor, Ronak A.; Metro, Michael J.

2014-01-01

High-intensity focused ultrasound can be used for the primary treatment of prostate cancer and biochemical recurrence after radical prostatectomy or radiation. Complications of high-intensity focused ultrasound include urinary retention, urethral stenosis, stress incontinence, urinary tract infections, dysuria, impotence, and rarely, rectourethral or rectovesicular fistula. We describe a patient presenting with urinary retention, urinary tract infections and intermittent stress incontinence, later found to be associated with pubic bone osteomyelitis stemming from a prostatopubic fistula. PMID:24917777

Medium term outcome of bipolar plasma vaporization in prostate cancer patients--a palliative modality of preserving spontaneous voiding.

PubMed

Geavlete, B; Moldoveanu, C; Niţă, Gh; Stănescu, F; Jecu, M; Geavlete, P

2012-12-15

This retrospective analysis evaluated the efficiency, safety, and medium term postoperative results of bipolar plasma vaporization (BPV) in prostate cancer (PCa) cases associating complete urinary retention. A series of 40 patients diagnosed with locally advanced or metastatic PCa and complete urinary retention requiring a Foley catheter indwelling underwent BPV aiming to restore spontaneous voiding. A total of 35 patients completed the one year evaluation protocol consisting of International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum flow rate (Q(max)) and post-voiding residual urinary volume (PVR), measured at 1, 3, 6 and 12 months after surgery. BPV was successfully performed in all cases with satisfactory efficiency, as confirmed by the mean operation time (42.8 minutes) and hemoglobin drop (0.7 g/dl). A fast and safe postoperative recovery period was described in this series (hematuria rate--7.5%; mean catheterization period--36 hours; mean hospital stay--2.5 days; early-irritative symptoms' rate--15%). At 1, 3, 6 and 12 months, satisfactory values were determined in terms of IPSS, Qmax, QoL and PVR. These parameters emphasized a stable evolution throughout the entire follow-up, as 88.6% of the patients maintained spontaneous voiding. The present trial confirmed the plasma-button vaporization as a promising therapeutic approach in PCa cases associating complete urinary retention. The technique displayed good efficacy, low perioperative morbidity, short convalescence, and satisfactory urodynamics and symptom score parameters during the one-year follow-up period.

Acute urinary retention: which catheter?

PubMed Central

Allardice, J. T.; Standfield, N. J.; Wyatt, A. P.

1988-01-01

There is no scientific data on which is the best method and catheter to use in acute urinary retention in males. We therefore compared the efficiency of a size 12 G latex rubber balloon catheter with a similar calibre but more expensive catheter made of polyvinyl-chloride (PVC). A total of 50 patients was studied and a 100% successful catheterisation rate was recorded at first attempt with both catheters, with no significant complications. The importance of the correct management of acute urinary retention, especially adequate analgesia, is stressed and it is concluded that either catheter is satisfactory. PMID:3207328

Indications and risk factors for midurethral sling revision.

PubMed

Unger, Cecile A; Rizzo, Anthony E; Ridgeway, Beri

2016-01-01

To determine the indications and risk factors for needing midurethral sling revision in a cohort of women undergoing midurethral sling placement. This was a case-control study of all women undergoing midurethral sling placement for stress urinary incontinence (SUI) between January 2003 and December 2013. Cases were patients who underwent midurethral sling placement followed by sling revision (incision, partial or complete excision). Controls were patients who underwent sling placement only. Once all subjects had been identified, the electronic medical record was queried for demographic and perioperative and postoperative data. Of 3,307 women who underwent sling placement, 89 (2.7%, 95% CI 1.9 - 3.4) underwent sling revision for one or more of the following indications: urinary retention (43.8%), voiding dysfunction (42.7%), recurrent urinary tract infection (20.2%), mesh erosion (21.3%), vaginal pain/dyspareunia (7.9%), and groin pain (3.4%). The median time from the index to the revision surgery was 7.8 months (2.3 - 17.9 months), but was significantly shorter in patients with urinary retention. The type of sling placed (retropubic or transobturator) was not associated with indication for revision. Patients who underwent revision surgery were more likely to have had previous SUI surgery (adjusted odds ratio 4.4, 95% CI 1.7 - 6.5) and to have undergone concomitant vaginal apical suspension (adjusted odds ratio 2.4, 95% CI 1.4 - 4.5). The rate of sling revision after midurethral sling placement was 2.7%. Urinary retention and voiding dysfunction were the most common indications. Patients with a history of previous SUI surgery and concomitant apical suspension at the time of sling placement may be at higher risk of requiring revision surgery.

Efficacy, Safety, and Durability of 532 nm Laser Photovaporization of the Prostate with GreenLight 180 W XPS in Men with Acute Urinary Retention.

PubMed

Goueli, Ramy; Meskawi, Malek; Thomas, Dominique; Hueber, Pierre-Alain; Tholomier, Côme; Valdivieso, Roger; Te, Alexis; Zorn, Kevin C; Chughtai, Bilal

2017-11-01

We assessed the effectiveness and durability of 532 nm laser photovaporization with GreenLight XPS in men with and without preoperative urinary retention. From 2010 to 2017 we prospectively studied men who underwent photovaporization of the prostate (PVP) for obstructive lower urinary tract symptoms (LUTS) secondary to BPH. The cohort was retrospectively divided into those with catheter dependent retention and those with elective PVP. Primary endpoints were catheter-free rate and improvement in quality of life (QoL) scores, international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), and postvoid residual (PVR). The secondary endpoints of the study were complication outcomes as defined by the standardized Clavien-Dindo grading system. One hundred thirty-seven men with preoperative retention and 195 men without preoperative retention underwent PVP. Men with preoperative retention were older (70 years vs 66 years; p < 0.001), had a higher American Society of Anesthesiology (ASA) score, and had a higher prevalence of neurologic disease (8% vs 2.6%; p = 0.04). These men also had a larger prostate volume (76 cc vs 69 cc; p < 0.001) and higher prostate specific antigen (5 ng/mL vs 2.7 ng/mL; p < 0.001) than those without retention. Patients with preoperative retention also had higher preoperative baseline IPSS and QoL score. After PVP they improved to values similar to those without retention, with durability up to 24 months. After PVP, men in preoperative retention had similar rates to fail their first void trial (18.2% vs 10.3%, p = 0.053). There was a 96% catheter-free rate in the men with preoperative retention. The rate of complication was higher in the nonretention group, specifically at 90 days (35.4% vs 21.2%; p = 0.009), with almost all the complications being Clavien-Dindo grade 2. PVP is an effective, safe, and durable treatment for men in acute urinary retention (AUR) with a catheter-free rate of 96%. The improvement is similar to those who did not present in AUR.

Investigation on the frailty status of the elderly inpatients in Shanghai using the FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire.

PubMed

Wei, Yin; Cao, Yanpei; Yang, Xiaoli; Xu, Yan

2018-05-01

This study was to investigate the frailty status of inpatients older than 65 years old in Shanghai.A 6-month cross-sectional survey was conducted using FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire. Totally 587 patients were included. The data, including demographic characteristics, constipation, urinary retention, urinary incontinence, grip strength, and muscle strength, were collected. The data of serum prealbumin, serum albumin, serum total protein, and hemoglobin were obtained from laboratory blood tests.The incidence of nonfrailty, prefrailty, and frailty was 0.249, 0.417, and 0.334, respectively. The high incidence age of frailty was 86 to 90 years old (0.342), and the high incidence age of prefrailty was 65 to 70 years old (0.282). There was significant difference in the grip strength among different degrees of frailty (P < .01). The influencing factors related to prefrailty included prealbumin, grip strength, urinary retention, constipation and education level of illiterate (P < .05). The populations with high prealbumin level, high grip strength and illiteracy population were not easy to enter the prefrailty period, while those with constipation (OR (odds ratio) = 1.867, 95% CI (confidence interval): 1.046-3.330) and urinary retention (OR = 7.007, 95% CI: 1.137-2.757) were more likely to enter the prefrailty period. Factors associated with frailty included age, prealbumin, grip strength, muscle strength, urinary incontinence, urinary retention, and constipation (P < .05). The populations with high prealbumin level, high grip strength, and high muscle strength were not easy to enter frailty period, while those with older age (OR = 1.141, 95% CI: 1.085-1.200), urinary incontinence (OR = 10.314, 95% CI: 1.950-54.548), urinary retention (OR = 3.058, 95% CI: 1.571-5.952), and constipation (OR = 3.004, 95% CI: 1.540-5.857) were easy to enter frailty period.The high incidence ages of frailty and prefrailty are 86 to 90 years old and 65 to 70 years old, respectively. Age, low education level, low grip strength, low muscle strength, low serum prealbumin, urinary retention, urinary incontinence, and constipation are the risk factors of frailty. It is recommended to include frailty as an indicator in the existing assessment to rate the disease and develop a disease observation plan.

Urinary retention during combined treatment of postpsychotic depression with duloxetine and olanzapine.

PubMed

Englisch, Susanne; Fritzinger, Michael; Zink, Mathias

2008-01-01

Duloxetine, a dual-reuptake inhibitor of serotonin and norepinephrine, has been approved for the treatment of major depressive episodes and for female stress urinary incontinence. At present, only sparse experiences are available regarding antidepressive treatment in patients with a psychotic lifetime diagnose, whereas this group of patients often suffer from major depressive episodes. Here, we describe the first case of a male patient with postpsychotic depression who developed the severe side effect of urinary retention during antidepressive treatment with duloxetine combined with olanzapine. After remission of his psychotic episode, the patient presented with depressed mood, psychomotor inhibition, sleep disturbance, and suicidal ideas. Without changing the antipsychotic therapy, we implemented duloxetine (60 mg/d) and the patient significantly improved. However, he increasingly suffered from obstructive voiding difficulties and complained about a weak urinary stream and incomplete voiding leading to unacceptable dribbling. The urinary retention disappeared completely within 1 week after discontinuation of duloxetine. We switched to venlafaxine (150 mg/d) and were able to keep the depression in remission. This case report demonstrates for the first time the onset of urinary retention in postpsychotic depression and during combined treatment with duloxetine and olanzapine. We therefore suggest increased attention on voiding function in particular if several pharmacological agents are combined.

Urinary retention due to herpes virus infections.

PubMed

Yamanishi, T; Yasuda, K; Sakakibara, R; Hattori, T; Uchiyama, T; Minamide, M; Ito, H

1998-01-01

Urinary retention is uncommon in patients with herpes zoster and anogenital herpes simplex. Seven patients (four men, three women) with a mean age of 68.1 years (range, 35-84) with urinary retention due to herpes zoster (n = 6) or anogenital herpes simplex (n = 1) were studied. Six patients had unilateral skin eruption in the saddle area (S2-4 dermatome) and one patient with herpes zoster had a skin lesion in the L4-5 dermatome. All patients had detrusor areflexia without bladder sensation, and two of them had inactive external sphincter on electromyography at presentation. Clean intermittent catheterization was performed, and voiding function was recovered in 4-6 weeks (average, 5.4) in all patients. Urodynamic study was repeated after recovery of micturition in three patients, and they returned to normal on cystometrography and external sphincter electromyography. Acute urinary retention associated with anogenital herpes infection has been thought to occur when the meninges or sacral spinal ganglia were involved, and, in conclusion, this condition may be considered to be reversible.

[A giant fecalith complicated by acute urinary retention, hydronephrosis and acute obstructive pyelonephritis].

PubMed

Davidov, M I

2016-04-01

The article reports a rare case of a 30-year-old man with Hirschsprung's disease, who developed a giant fecalith in the rectum and sigmoid (weight 3.5 kg, the largest diameter 20 cm). The fecalith impaired urine flow by compressing urinary tract, thereby causing acute urinary retention and right-sided hydronephrosis with acute obstructive pyelonephritis. Removing fecalith resulted in the patient recovery and normal functioning of genitourinary system.

Transrectal ultrasound-guided extraction of impacted prostatic urethral calculi: a simple alternative to endoscopy

PubMed Central

Amend, Gregory; Gandhi, Jason; Smith, Noel L.; Weissbart, Steven J.; Schulsinger, David A.; Joshi, Gargi

2017-01-01

Urethral stones can become impacted in the posterior urethra, typically presenting with varying degrees of acute urinary retention and lower urinary tract symptoms. These are traditionally treated in the inpatient setting, with external urethrotomy or endoscopic push-back of the calculus into the urinary bladder followed by cystolitholapaxy or cystolithotripsy. However, these methods are invasive, involve general anesthesia, and require radiation. In this report, we describe a simple, minimally invasive, and safe alternative technique to visualize and remove impacted prostatic urethral stones under the real-time guidance of transrectal ultrasonography (TRUS). The urologist can accomplish this procedure in the office, avoiding radiation exposure to the patient and hospital admission. PMID:28725602

Bladder rupture caused by postpartum urinary retention.

PubMed

Dueñas-García, Omar Felipe; Rico, Hugo; Gorbea-Sanchez, Viridiana; Herrerias-Canedo, Tomas

2008-08-01

Postpartum bladder rupture is an uncommon surgical emergency and a diagnostic challenge. A primigravida delivered a healthy newborn without complications at 39.4 weeks of gestation. The patient was admitted 80 hours postpartum with abdominal pain, oliguria, hematuria, and pain that worsened during the previous 4 hours. An inserted Foley catheter drained only a small amount of urine, and serum creatinine was elevated (3.5 mg/dL). A laparotomy was performed and revealed a 10-cm hole in the urinary bladder. The bladder was repaired and the patient was discharged 15 days after surgery. The follow-up cystoscopy revealed adequate healing of the bladder. Urinary retention can lead to serious complications, including bladder rupture. Postpartum bladder rupture due to urinary retention should be ruled out if there is a history of abdominal pain, oliguria, and elevated of serum creatinine.

Rare presentation of acute urinary retention secondary to herpes zoster.

PubMed

Ginsberg, P C; Harkaway, R C; Elisco, A J; Rosenthal, B D

1998-09-01

There are many causes of acute urinary retention. Reported here is a case of one of the more rare causes: herpes zoster. Fewer than 70 cases have been reported in the literature since 1890. In the present clinical environment where many patients are immunocompromised, reports of herpes zoster and its sequelae are no longer thought of as anecdotal. The virus may interrupt the detrusor reflex due to involvement of the sacral dorsal root ganglia. Urinary retention with sensory loss of both bladder and rectum as well as flaccid paralysis of the detrusor can develop in patients with herpes zoster. Fortunately, the outcome of this process is benign and full recovery of the detrusor is likely.

Long-term results of sacral neuromodulation for women with urinary retention.

PubMed

Dasgupta, Ranan; Wiseman, Oliver J; Kitchen, Neil; Fowler, Clare J

2004-08-01

OBJECTIVE ; To review the long-term results of sacral nerve stimulation in the treatment of women with Fowler's syndrome, over a 6-year period at one tertiary referral centre. Between 1996 and 2002, 26 women with urinary retention were treated by implanting a sacral nerve stimulator. Their case records were reviewed for follow-up, complications and revision procedures, and the most recent uroflowmetry results. There were 20 patients (77%) still voiding spontaneously at the time of review (with two having deactivated their stimulator because of pregnancy). Fourteen patients (54%) required revision surgery, and the most common complications included loss of efficacy, implant-related discomfort and leg pain. The mean postvoid residual volume was 75 mL and mean maximum flow rate 20.8 mL/s. In young women with retention, for whom there is still no alternative to lifelong self-catheterization, sacral neuromodulation is effective for up to 5 years after implantation. However, there was a significant complication rate, in line with other reports, which may be improved by new technical developments.

Elsberg syndrome: a neurologic basis for acute urinary retention in patients with genital herpes.

PubMed

Hemrika, D J; Schutte, M F; Bleker, O P

1986-09-01

Three patients with genital herpes simplex type II primoinfection and acute urinary retention are described. All patients showed pleocytosis of the cerebrospinal fluid, substantiating central nervous involvement. The association of genital herpes and sacral (myelo-) radiculitis has gained little attention in gynecologic literature, yet it is not an uncommon finding in female patients suffering from herpes. The present report emphasizes the importance of urinary symptoms in genital herpes and reviews the literature on similar cases.

Cystoscopy and Ureteroscopy

MedlinePlus

... urinary urgency—the inability to delay urination urinary retention —the inability to empty the bladder completely urinary ... Coordinating Committees Strategic Plans & Reports Research Areas FAQs Jobs at NIDDK Visit Us Contact Us News News ...

Electroacupuncture versus sham electroacupuncture for urinary retention in poststroke patients: study protocol for a multicenter, randomized controlled trial.

PubMed

Shin, Seungwon; Lee, Jiwon; Yoo, Junghee; Lim, Sung Min; Lee, Euiju

2016-04-12

This study protocol evaluates the effectiveness of adjuvant electroacupuncture (EA) for urinary retention in poststroke patients undergoing conventional treatments, in comparison with that of a sham control. A multicenter, blinded, randomized controlled trial will be conducted in three hospitals in the Republic of Korea. We are recruiting 54 stroke survivors (aged >19 years), who were diagnosed with urinary retention based on the results of two consecutive post-void residual (PVR) tests, and dividing them randomly into two arms: the EA and Park-sham control groups. They will receive ten sessions of EA or sham treatment for 2 weeks. The participants will be blinded with non-penetrating needles and fake sounds of EA stimulators. The daily PVR ratio will be primarily measured at baseline and at the end of the study to statistically test the effectiveness of EA for poststroke urinary retention. Then, the Korean version of the Qualiveen Questionnaire, the Korean version of the International Prostate Symptom Score, and the blinding index will be assessed. After each EA session or sham EA, adverse events will be reported to evaluate the safety of EA. Results will be analyzed by using the independent t-test or Mann-Whitney U test, based on both intention-to-treat and per-protocol principles. The findings will provide clinical evidence for the effectiveness of EA treatment to improve urinary retention in stroke survivors. This study protocol was registered in ClinicalTrials.gov (NCT02472288) on 10 June 2015.

Neurogenic bladder from occult herpes zoster.

PubMed

Rothrock, J F; Walicke, P A; Swenson, M R

1986-11-01

Active infection with herpes zoster may cause acute urinary retention, especially when it involves sacral dermatomes. Although frank retention usually develops days to weeks after eruption of the typical rash, bladder incompetence infrequently develops first, raising concern over other, more ominous etiologies. In the case presented, rash appearance was delayed until six weeks after the initial onset of urinary retention, a much longer interval than previously reported. Occult herpes zoster infection should be considered in patients presenting with an acute neurogenic bladder of obscure cause.

Urine culture - catheterized specimen

MedlinePlus

... you may feel pressure. If you have a urinary tract infection , you may have some pain when the catheter ... on their own If you might have a urinary tract infection If you cannot empty your bladder (urinary retention) ...

Bladder Infection (Urinary Tract Infection - UTI) in Adults

MedlinePlus

... Prostate Enlargement (Benign Prostatic Hyperplasia) Urinary Diversion Urinary Retention Urine Blockage in Newborns Vesicoureteral Reflux (VUR) The ... Coordinating Committees Strategic Plans & Reports Research Areas FAQs Jobs at NIDDK Visit Us Contact Us News News ...

Meningitis-retention syndrome. An unrecognized clinical condition.

PubMed

Sakakibara, Ryuji; Uchiyama, Tomoyuki; Liu, Zhi; Yamamoto, Tatsuya; Ito, Takashi; Uzawa, Akiyuki; Suenaga, Tadahiro; Kanai, Kazuaki; Awa, Yusuke; Sugiyama, Yoshiki; Hattori, Takamichi

2005-12-01

A combination of acute urinary retention and aseptic meningitis has not been well known. This combination can be referred to as meningitis-retention syndrome (MRS), when accompanied by no other abnormalities. To describe the results of a uro-neurological assessment in our patients with MRS. In three patients (two men, one woman; age, 34-68 years), we performed urodynamic studies and relevant imaging and neurophysiological tests, in addition to cerebrospinal fluid (CSF) examination. All three patients developed acute urinary retention along with headache, fever and stiff neck. None had obvious neurological abnormalities, other than a slightly brisk reflex in the lower extremities. One had previously experienced generalized erythematous eruptions, but none had pain, hypalgesia or skin eruptions in the sacral dermatomes suggestive of Elsberg syndrome (infectious sacral polyradiculitis; mostly genital herpes). Brain/spinal/lumbar plexus MRI scans and nerve conduction studies were normal. CSF examination showed mild mononuclear pleocytosis, increased protein content, and normal to mildly decreased glucose content in all patients; increased myelin basic protein suggestive of central nervous system demyelination in one; and increased viral titers in none. Urodynamic study revealed, during the voiding phase, an underactive detrusor in all patients and an unrelaxing sphincter in one. These clinical manifestations were ameliorated within 3 weeks. We reported three cases of MRS, a peculiar syndrome that could be regarded as a mild variant of acute disseminated encephalomyelitis (ADEM). Urinary retention might reflect acute shock phase of this disorder. Although MRS has a benign and self-remitting course, management of the acute urinary retention is necessary.

Estimating mineral requirements of Nellore beef bulls fed with or without inorganic mineral supplementation and the influence on mineral balance.

PubMed

Zanetti, D; Godoi, L A; Estrada, M M; Engle, T E; Silva, B C; Alhadas, H M; Chizzotti, M L; Prados, L F; Rennó, L N; Valadares Filho, S C

2017-04-01

The objectives of this study were to quantify the mineral balance of Nellore cattle fed with and without Ca, P, and micromineral (MM) supplementation and to estimate the net and dietary mineral requirement for cattle. Nellore cattle ( = 51; 270.4 ± 36.6 kg initial BW and 8 mo age) were assigned to 1 of 3 groups: reference ( = 5), maintenance ( = 4), and performance ( = 42). The reference group was slaughtered prior to the experiment to estimate initial body composition. The maintenance group was used to collect values of animals at low gain and reduced mineral intake. The performance group was assigned to 1 of 6 treatments: sugarcane as the roughage source with a concentrate supplement composed of soybean meal and soybean hulls with and without Ca, P, and MM supplementation; sugarcane as the roughage source with a concentrate supplement composed of soybean meal and ground corn with and without Ca, P, and MM supplementation; and corn silage as the roughage source with a concentrate supplement composed of soybean meal and ground corn with and without Ca, P, and MM supplementation. Orthogonal contrasts were adopted to compare mineral intake, fecal and urinary excretion, and apparent retention among treatments. Maintenance requirements and true retention coefficients were generated with the aid of linear regression between mineral intake and mineral retention. Mineral composition of the body and gain requirements was assessed using nonlinear regression between body mineral content and mineral intake. Mineral intake and fecal and urinary excretion were measured. Intakes of Ca, P, S, Cu, Zn, Mn, Co, and Fe were reduced in the absence of Ca, P, and MM supplementation ( < 0.05). Fecal excretion of Ca, Cu, Zn, Mn, and Co was also reduced in treatments without supplementation ( < 0.01). Overall, excretion and apparent absorption and retention coefficients were reduced when minerals were not supplied ( < 0.05). The use of the true retention coefficient instead of the true absorption coefficient provided a better estimate of mineral requirements. Dietary mineral requirements were lower for P, Cu, and Zn and greater for Fe compared with previously published recommendations. This study provides useful information about mineral requirements and mineral supplementation to obtain adequate dietary mineral supply of Nellore cattle in tropical conditions.

Hyperammonemia in Urinary Tract Infections.

PubMed

Kenzaka, Tsuneaki; Kato, Ken; Kitao, Akihito; Kosami, Koki; Minami, Kensuke; Yahata, Shinsuke; Fukui, Miho; Okayama, Masanobu

2015-01-01

The present study investigated the incidence of hyperammonemia in urinary tract infections and explored the utility of urinary obstruction relief and antimicrobial administration to improve hyperammonemia. This was an observational study. Subjects were patients who were diagnosed with urinary tract infection and hospitalized between June 2008 and June 2009. We measured plasma ammonia levels on admission in patients who were clinically diagnosed with urinary tract infection and hospitalized. We assessed each patient's level of consciousness on admission using the Glasgow Coma Scale (GCS) and performed urine and blood cultures. We also assessed hearing prior to hospitalization using the Eastern Cooperative Oncology Group performance status (ECOG-PS). In cases with high ammonia levels on admission, plasma ammonia and GCS were measured 24 hours and 5-7 days later. Sixty-seven candidates were enrolled; of these, 60 cases (89.6%) with bacterial cell counts ≥10(4) CFU/mL were studied. Five cases (8.3%) presented with high plasma ammonia levels. Cases with hyperammonemia were significantly more likely to present with low GCS scores and urinary retention rate. All five cases received antimicrobial therapy with an indwelling bladder catheter to relieve urinary retention. The case 5 patient died shortly after admission due to complicated aspiration pneumonia; in the remaining cases, plasma ammonia levels were rapidly normalized and the level of consciousness improved. The occurrence of hyperammonemia in urinary tract infections is not rare. The cause of hyperammonemia is urinary retention obstruction. Therefore, along with antimicrobial administration, relief of obstruction is important for the treatment of hyperammonemia caused by this mechanism.

Type I female genital mutilation: a cause of completely closed vagina.

PubMed

Rouzi, Abdulrahim A; Sahly, Nora; Alhachim, Estabraq; Abduljabbar, Hassan

2014-09-01

Female genital mutilation (FGM) ranges in severity from a nick of the clitoris to partial or total removal of the external genitalia. Sexual complications after FGM include sexual dysfunction, difficult intercourse, and dyspareunia. We report a case of Type I FGM presenting as complete vaginal closure and urinary retention. A 16-year-old adolescent was referred for obliterated vagina and urinary retention. She had recurrent urinary tract infections, difficulty in voiding, and cyclic hematuria. At the age of 1 year she had been taken by her mother to a pediatric surgeon to have a Type I FGM procedure. On examination, the urethral meatus and vaginal orifices were completely closed by the FGM scar. She underwent uneventful surgical opening of the vagina. A normal vaginal orifice was created and normal flow of urine and menses occurred. Type I FGM can present as complete vaginal closure and urinary retention. Proper diagnosis and treatment are of paramount importance. © 2014 International Society for Sexual Medicine.

Acute urinary retention due to HSV-1: a case report.

PubMed

Mancino, P; Dalessandro, M; Falasca, K; Ucciferri, C; Pizzigallo, E; Vecchiet, J

2009-03-01

Complications in urinary tract nervous routes due to herpes viruses as VZV and HSV-2 are well known. Acute urinary retention and chronic neuropathic pain are not rare when sacral dermatomes are involved by these viruses. However, an analogous condition has not yet been clearly ascribed to HSV-1 infection. We present a 32-year-old immunocompetent patient with fever, lumbar pain and acute urinary retention who had never had herpetic clinical manifestations. Urodynamic studies diagnosed a neurologic bladder with an absent filling sensation. Cystoscopic assessment revealed the presence of reddened and isolated small mucosal areas in the bladder walls. The search for herpes viruses in plasma and CSF by PCR assay were positive for HSV-1. After treatment with antiviral therapy the disease resolved. Intermittent catheterization was necessary and voiding dysfunction resolved after three weeks by its appearance. Neurological damage to the central nervous system (CNS) and/or PNS due to HSV-1 seems to be the most likely reason. The course of disease was benign and self-remitting.

Total plasma clearance versus urinary plasma clearance of (51)Cr-EDTA in patients with cirrhosis with and without fluid retention.

PubMed

Henriksen, Ulrik L; Hansen, Hanne B; Ring-Larsen, Helmer; Bendtsen, Flemming; Henriksen, Jens H

2015-01-01

In patients with fluid retention, the total plasma clearance of (51)Cr-EDTA (ClP) may overestimate the glomerular filtration rate (GFR). The present study was therefore undertaken in order to compare ClP with the urinary plasma clearance of (51)Cr-EDTA (ClU) in patients with cirrhosis with and without fluid retention. A total of 136 patients with cirrhosis (24 without fluid retention, 112 with ascites) received a quantitative intravenous injection of (51)Cr-EDTA followed by plasma and quantitative urinary samples for 5 hours. ClP was determined from the injected dose relative to the plasma concentration-time area, extrapolated to infinity. ClU was determined as urinary excretion relative to the plasma concentration-time area up to voiding. In patients without fluid retention, the difference between ClP and ClU (ClP - ClU = ClΔ) was mean 4.5 mL/min/1.73 m(2). In patients with ascites, ClΔ was significantly higher (17.6 mL/min/1.73 m(2), p < 0.0001). ClΔ increased with lower values of GFR (r = - 0.458, p < 0.001). Repeated measurements of ClU in a subgroup of patients with fluid retention (n = 25) gave almost identical values. Different types of corrections of one-pool clearance were almost identical with ClP, except for higher clearance values, which were somewhat underestimated by the former. In patients with fluid retention and ascites ClP and corrected one-pool clearance overestimates GFR substantially. Although ClU may underestimate GFR slightly, patients with ascites should collect urine quantitatively in order to obtain a reliable measurement of GFR.

Acute urinary retention in women due to urethral calculi: A rare case

PubMed Central

Turo, Rafal; Smolski, Michal; Kujawa, Magda; Brown, Stephen C.W.; Brough, Richard; Collins, Gerald N.

2014-01-01

We present a case of a 51-year-old woman with acute urinary retention caused by a urethral calculus. Urethral calculi in women are extremely rare and are usually formed in association with underlying genitourinary pathology. In this case, however, no pathology was detected via thorough urological evaluation. We discuss the pathogenesis, clinical presentation and treatment of urethral calculi. To our knowledge, this is the second reported case of a primary urethral calculus in a female with an anatomically normal urinary tract and the first in a middle-aged Caucasian female. PMID:24554984

Open-label study evaluating outpatient urethral sphincter injections of onabotulinumtoxinA to treat women with urinary retention due to a primary disorder of sphincter relaxation (Fowler's syndrome).

PubMed

Panicker, Jalesh N; Seth, Jai H; Khan, Shahid; Gonzales, Gwen; Haslam, Collette; Kessler, Thomas M; Fowler, Clare J

2016-05-01

To assess the efficacy (defined as improvements in maximum urinary flow rate [Qmax ] of ≥50%, post-void residual urine volume [PVR] and scores on the International Prostate Symptom Score [IPSS] questionnaire) and safety of urethral sphincter injections of onabotulinumtoxinA in women with a primary disorder of urethral sphincter relaxation, characterised by an elevated urethral pressure profile (UPP) and specific findings at urethral sphincter electromyography (EMG), i.e. Fowler's syndrome. In this open-label pilot Institutional Review Board-approved study, 10 women with a primary disorder of urethral sphincter relaxation (elevated UPP, sphincter volume, and abnormal EMG) presenting with obstructed voiding (five) or in complete urinary retention (five) were recruited from a single tertiary referral centre. Baseline symptoms were assessed using the IPSS, and Qmax and PVR were measured. After 2% lidocaine injection, 100 U of onabotulinumtoxinA was injected into the striated urethral sphincter, divided on either side, under EMG guidance. Patients were reviewed at 1, 4 and 10 weeks after injection, and assessed using the IPSS, Qmax and PVR measurements. The UPP was repeated at week 4. The mean (range) patient age was 40 (25-65) years, and the mean symptom scores on the IPSS improved from 25.6 to 14.1, and the mean 'bother' score reduced from 6.1 to 3.5 at week 10. As compared with a baseline mean Qmax of 8.12 mL/s in the women who could void, the Qmax improved to 15.8 mL/s at week 10. Four of the five women in complete retention could void spontaneously, with a mean Qmax of 14.3 mL/s at week 10. The mean PVR decreased from 260 to 89 mL and the mean static UPP improved from 113 cmH2 O at baseline to 90 cmH2 O. No serious side-effects were reported. Three women with a history of recurrent urinary tract infections developed a urinary tract infection. There were no reports of stress urinary incontinence. Seven of the 10 women opted to return for repeat injections. This pilot study shows an improvement in patient-reported lower urinary tract symptoms, and the objective parameters of Qmax , PVR and UPP, at 10 weeks after urethral sphincter injections of onabotulinumtoxinA. No serious side-effects were reported. This treatment could represent a safe outpatient treatment for young women in retention due to a primary disorder of urethral sphincter relaxation. However, a larger study is required to confirm the findings of this pilot study. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Sacral root neuromodulation in idiopathic nonobstructive chronic urinary retention.

PubMed

Shaker, H S; Hassouna, M

1998-05-01

Sacral root neuromodulation is becoming a superior alternative to the standard treatment of idiopathic nonobstructive urinary retention. We report results in 20 successive patients who underwent sacral foramen implantation to restore bladder function. After an initial, thorough baseline assessment 20 patients 19.43 to 55.66 years old with idiopathic nonobstructive urinary retention underwent percutaneous nerve evaluation. Response was assessed by a detailed voiding diary. Responders underwent implantation with an S3 foramen implant, and were followed 1, 3 and 6 months postoperatively, and every 6 months thereafter. Sacral root neuromodulation restored voiding capability in these patients. Bladders were emptied with minimal post-void residual urine, which decreased from 78.3 to 5.5 to 10.2% of the total voided volume from baseline to postoperative followup. These results were reflected in uroflowmetry and pressure-flow studies, which were almost normal after implantation. Furthermore, the urinary tract infection rate decreased significantly and associated pelvic pain improved substantially. The Beck depression inventory and SF-36 quality of life questionnaire indicated some improvement but reached significance in only 1 item. In addition, cystometrography showed no significant difference after 6 months of implantation compared with baseline values. Complications were minimal and within expectations. Sacral root neuromodulation is an appealing, successful modality for nonobstructive urinary retention. Only patients who have a good response to percutaneous nerve evaluation are candidates for implantation. The high efficacy in patients who undergo implantation, relative simplicity of the procedure and low complication rate make this a treatment breakthrough in this difficult group.

Transurethral plasmakinetic resection of the prostate is a reliable minimal invasive technique for benign prostate hyperplasia: a meta-analysis of randomized controlled trials.

PubMed

Wang, Kai; Li, Yao; Teng, Jing-Fei; Zhou, Hai-Yong; Xu, Dan-Feng; Fan, Yi

2015-01-01

To evaluate the efficacy and safety of plasmakinetic resection of the prostate (PKRP) versus transurethral resection of the prostate (TURP) for the treatment of patients with benign prostate hyperplasia (BPH), a meta-analysis of randomized controlled trials was carried out. We searched PubMed, Embase, Web of Science and the Cochrane Library. The pooled estimates of maximum flow rate, International Prostate Symptom Score, operation time, catheterization time, irrigated volume, hospital stay, transurethral resection syndrome, transfusion, clot retention, urinary retention and urinary stricture were assessed. There was no notable difference in International Prostate Symptom Score between TURP and PKRP groups during the 1-month, 3 months, 6 months and 12 months follow-up period, while the pooled Q max at 1-month favored PKRP group. PKRP group was related to a lower risk rate of transurethral resection syndrome, transfusion and clot retention, and the catheterization time and operation time were also shorter than that of TURP. The irrigated volume, length of hospital stay, urinary retention and urinary stricture rate were similar between groups. In conclusion, our study suggests that the PKRP is a reliable minimal invasive technique and may anticipatorily prove to be an alternative electrosurgical procedure for the treatment of BPH.

Herpes zoster induced neuropathic bladder--a case report.

PubMed

Tsai, Hsiu-Nan; Wu, Wen-Jeng; Huang, Shu-Pin; Su, Chin-Ming; Chen, Chung-Chin; Wang, Chii-Jye; Chou, Yii-Her; Huang, Chun-Hsiung

2002-01-01

Herpes zoster infection involving the sacral dermatomes has been associated with bladder dysfunction and, although rarely, with acute urinary retention. Less than 150 cases have been reported in the literature. After reviewing our institute's chart records covering a period of time dating from 1991 to 2001, we found that three of our patients had developed acute urinary retention following herpes zoster skin lesions of the S2-4 dermatomes. Herein we report our findings. These three patients had previously been found to have normal voiding status. However, at the time of complaint urodynamic studies revealed detrusor areflexia or detrusor hyporeflexia with decreased sensation of bladder filling. After micturation recovery, repeat urodynamic studies revealed detrusor pressure and bladder sensation recovery. After one to six weeks of treatment, all three patients could void spontaneously without catheterization. We found that, when treated with antiviral medication, supportive analgesics, and temporary urinary drainage, which included urethral catheterization and suprapubic cystostomy, acute urinary retention associated with herpes zoster has a generally favorable prognosis. In other words, we found that in spite of its rarity, herpes zoster induced neuropathic bladder dysfunction is reversible when treated appropriately.

Erectile Dysfunction

MedlinePlus

... Prostate Enlargement (Benign Prostatic Hyperplasia) Urinary Diversion Urinary Retention Urine Blockage in Newborns Vesicoureteral Reflux (VUR) The ... Coordinating Committees Strategic Plans & Reports Research Areas FAQs Jobs at NIDDK Visit Us Contact Us News News ...

Prostate Problems

MedlinePlus

... Prostate Enlargement (Benign Prostatic Hyperplasia) Urinary Diversion Urinary Retention Urine Blockage in Newborns Vesicoureteral Reflux (VUR) The ... Coordinating Committees Strategic Plans & Reports Research Areas FAQs Jobs at NIDDK Visit Us Contact Us News News ...

Kegel Exercises

MedlinePlus

... Prostate Enlargement (Benign Prostatic Hyperplasia) Urinary Diversion Urinary Retention Urine Blockage in Newborns Vesicoureteral Reflux (VUR) The ... Coordinating Committees Strategic Plans & Reports Research Areas FAQs Jobs at NIDDK Visit Us Contact Us News News ...

Vesicoureteral Reflux

MedlinePlus

... problems, such as urinary incontinence , bedwetting , and urinary retention bowel problems, such as constipation Most children with ... Coordinating Committees Strategic Plans & Reports Research Areas FAQs Jobs at NIDDK Visit Us Contact Us News News ...

Simple prostatectomy

MedlinePlus

... if you have: Problems emptying your bladder (urinary retention) Frequent urinary tract infections Frequent bleeding from the ... to internal organs Erection problems (impotence) Loss of sperm fertility ( infertility ) Passing semen back up into the ...

The changing practice of transurethral resection of the prostate.

PubMed

Young, M J; Elmussareh, M; Morrison, T; Wilson, J R

2018-04-01

Introduction Transurethral resection of the prostate (TURP) is considered the gold standard surgical treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The number of TURPs performed has declined significantly over the last three decades owing to pharmaceutical therapy. TURP data from a single institution for the years 1990, 2000 and 2010 were compared to assess the difference in performance. Methods A retrospective analysis was undertaken of all patients who underwent TURP between January and December 2010. These findings were compared with historical data for the years 1990 and 2000: 100 sets of case notes were selected randomly from each of these years. Results The number of TURPs performed fell from 326 in 1990 to 113 in 2010. The mean age of patients increased from 70.6 years to 74.0 years. There was also a significant increase in the mean ASA grade from 1.9 to 2.3. The most common indication for TURP shifted from LUTS to acute urinary retention. No significant change in operating time was observed. The mean resection weight remained constant (22.95g in 1990, 22.55g in 2000, 20.76g in 2010). A reduction in transfusion rates was observed but there were higher rates of secondary haematuria and bladder neck stenosis. There was an increase from 2% to 11.5% of patients with long-term failure to void following TURP. Conclusions The number of TURPs performed continues to decline, which could lead to potential training issues. Urinary retention is still by far the most common indication. However, there has been a significant rise in the percentage of men presenting for TURP with high pressure chronic retention. The number of patients with bladder dysfunction who either have persistent storage LUTS or eventually require long-term catheterisation or intermittent self-catheterisation has increased markedly, which raises the question of what the long-term real life impact of medical therapy is on men with LUTS secondary to benign prostatic hyperplasia who eventually require surgery.

Neuromodulation by implant for treating lower urinary tract symptoms and dysfunction.

PubMed

Bemelmans, B L; Mundy, A R; Craggs, M D

1999-08-01

Patients with irritative micturition complaints, pelvic pain, involuntary urine loss or urinary retention are sometimes difficult to treat. The advent of direct sacral nerve stimulation offers a therapeutic alternative if conservative measures fail and surgery is considered. This paper reviews therapeutic neuromodulation by implant for treating lower urinary tract symptoms and dysfunction. The international literature is reviewed on topics such as the physiological basis of neuromodulation, techniques of acute testing and chronic implantation, and clinical results. Future developments and ways for possible improvement are discussed. The mode of action of neuromodulation is probably through restoring the correct balance between excitatory and inhibitory impulses from and to the pelvic organs at a sacral and supra-sacral level. Depending on the predefined success criteria, average success rates of definitive implants vary from 50 to 70%. From the data it seems that patients with urge incontinence and urinary retention are the best candidates for neuromodulation. In the literature the lack of standardisation of selection criteria, stimulation parameters and definitions of success is striking. Neuromodulation by implant is a useful therapeutic alternative. It should at least be considered in patients with therapy-resistant urge incontinence and urinary retention before proceeding to surgery. Issues such as underlying physiology, methodological standardisation, technical improvements, and patient selection must be addressed in future research.

Kidney Stones in Children

MedlinePlus

... Prostate Enlargement (Benign Prostatic Hyperplasia) Urinary Diversion Urinary Retention Urine Blockage in Newborns Vesicoureteral Reflux (VUR) The ... Coordinating Committees Strategic Plans & Reports Research Areas FAQs Jobs at NIDDK Visit Us Contact Us News News ...

Sacral neuromodulation for lower urinary tract dysfunction.

PubMed

Van Kerrebroeck, Philip E V; Marcelissen, Tom A T

2012-08-01

To review the technique, indications, results and working mechanisms of sacral neuromodulation (SNM) for lower urinary tract dysfunction. The available literature on SNM for lower urinary tract dysfunction was searched. Based on the information available in the literature and also based on personal experience, the urological indications, technique, mechanisms of action and results of SNM are presented and discussed. SNM for lower urinary tract dysfunction involves stimulation of the 3rd sacral nerve with an electrode implanted in the sacral foramen and connected to a pulse generator. The technique is accepted by the FDA since 1997. Currently, SNM for lower urinary tract dysfunction has been successfully used in about 26,000 patients with various forms of lower urinary tract dysfunction, including urgency, frequency and urgency incontinence as well as non-obstructive urinary retention. The actual procedure of SNM consists of a minimal invasive technique and is effective in about 70% of the patients who have been implanted with a permanent system. Also, in pelvic pain, interesting results have been described. SNM modulates the micturition reflexes at different levels in the central nervous system. Sacral neuromodulation is a safe and effective therapy for various forms of lower urinary tract dysfunction, including urgency, frequency and urgency incontinence as well as non-obstructive urinary retention. It should be the first choice after failure of maximal conservative therapy.

21 CFR 876.5130 - Urological catheter and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... device that is inserted through the urethra and used to pass fluids to or from the urinary tract. This..., coude catheters, balloon retention type catheters, straight catheters, upper urinary tract catheters...

Chronic urinary retention in men: how we define it, and how does it affect treatment outcome.

PubMed

Negro, Carlo L A; Muir, Gordon H

2012-12-01

What's known on the subject? and What does the study add? Chronic urinary retention (CUR) is a poorly defined entity, as the key element of definition, significant postvoid residual urine volume (PVR), has not a worldwide and moreover evidenced-based definition. There is no agreement on which is the threshold value to define a significant PVR and different society produced guidelines with different thresholds ranging from 300 mL to 1000 mL. Diagnosis is difficult, and management has not been defined yet. There is a lack of studies on the best management of these patients, as this group of patients has always been considered at high risk of failure. Only one study compares conservative with the surgical management but it is not a randomised controlled trail. This review offers a systematic appraisal of the most recent publications on CUR. It indicates the absence of a real worldwide agreed definition, as the two keys element of it are not satisfactorily defined yet: significant PVR, is suffering from a lack of evidenced-based definition, and percussable or palpable bladder is a very nebulous concept as it is not a criteria of certainty as different individual variables affect it. This has an important effect on management which is not structured. Most of the trials involving benign prostatic hyperplasia treatments (either medical or surgical) tend to exclude this group of patients, which is a clinically important group, comprising up to a quarter of men undergoing TURP in the UK. Urinary retention describes a bladder that does not empty completely or does not empty at all. Historically, urinary retention has been classified as either acute or chronic the latter is generally classified as high pressure or low pressure according to the bladder filling pressure on urodynamic. A MEDLINE® search for articles written in English and published before January 2010 was done using a list of terms related to urinary retention: 'urinary retention', 'chronic urinary retention' and 'PVR'. Chronic urinary retention (CUR) is defined by the International Continence Society as 'a non-painful bladder, which remains palpable or percussable after the patient has passed urine'. Abrams was the first to choose a residual urine volume >300 mL to define CUR as he considered it the minimum volume at which the bladder becomes palpable suprapubically. The UK National Institute for Health and Clinical Excellence lower urinary tract symptoms (LUTS) guidelines define CUR as a postvoid residual urine volume (PVR) of >1000 mL. No studies have specifically addressed the problem of quantifying the minimum amount of urine present in the bladder to define CUR. Nor did we find any publications objectively assessing at what amount of urine a bladder can be palpable. The ability to feel a bladder may rely on variables (i.e. medical skills and patient habitus). There is a marked variability of PVR, so the test should be repeated to improve precision. As defining CUR is difficult, structured management is challenging. Nearly all prospective trials exclude men with CUR from analysis, possibly anticipating a poor outcome and a high risk of complications. However, men with CUR are a clinically important group, comprising up to 25% of men undergoing transurethral resection of the prostate. Definition of CUR is imprecise and arbitrary. Most studies seem to describe the condition as either a PVR of >300 mL in men who are voiding, or >1000 mL in men who are unable to void. This confusion leads to an inability to design and interpret studies; indeed most prospective trials simply exclude these patients. There is a clear need for internationally accepted definitions of retention to allow both treatment and reporting of outcomes in men with LUTS, and for such definitions to be used by all investigators in future trials. © 2012 BJU INTERNATIONAL.

Sacral neuromodulations for female lower urinary tract, pelvic floor, and bowel disorders.

PubMed

Wehbe, Salim A; Whitmore, Kristene; Ho, Mat H

2010-10-01

In recent years, sacral neuromodulation (SNM) has been investigated for the treatment of various types of lower urinary tract and bowel dysfunctions. This review discusses recently published data related to the therapeutic applications of SNM in female lower urinary tract, pelvic floor, and bowel disorders. SNM has been employed initially in the treatment of refractory idiopathic overactive bladder, urge urinary incontinence, and chronic nonobstructive urinary retention. Since then, several studies, including randomized and controlled trials, have confirmed the therapeutic effects of SNM in these disorders. The applications of SNM are now extended to the treatment of other female pelvic problems, such as fecal incontinence, chronic constipation, interstitial cystitis/painful bladder syndrome, sexual dysfunction, and neurogenic disorders, with similar promising results. SNM is approved by the Food and Drug Administration for the treatment of idiopathic overactive bladder, urge urinary incontinence, and chronic nonobstructive urinary retention. SNM is not yet an approved method for the treatment of other pelvic disorders, but data supporting its benefit are emerging. The major advantage of SNM lies in its potential to treat the bladder, urethral sphincter, anal sphincters, and pelvic floor muscles simultaneously, which might result in better therapeutic effects.

Clinical results from first use of prostate stent as fiducial for radiotherapy of prostate cancer.

PubMed

Carl, Jesper; Nielsen, Jane; Holmberg, Mats; Larsen, Erik Hoejkjaer; Fabrin, Knud; Fisker, Rune V

2011-05-01

A clinical feasibility study using a removable prostate stent as fiducial for image-guided radiotherapy (IGRT) of localized prostate cancer (PC). The study included patients with local or locally advanced PC. The clinical target volume (CTV) was outlined on magnetic resonance (MR) images co-registered to planning computer tomography (CT) images. Daily online IGRT was delivered using the stent as fiducial. Risk of migration was estimated using multiple MR. Acute urinary toxicity was scored using the international prostate symptom score (IPSS). Late gastro-intestinal (GI) and genito-urinary (GU) toxicity was scored using the Radio Therapy Oncology Group (RTOG) score, biochemical failure (BF) was defined as an elevation of prostate specific antigen (PSA) above nadir plus 2 ng/ml after radiotherapy. One hundred men were enrolled in the study. Ninety completed radiotherapy with the stent as fiducial. No migration of the stent was seen, but three cases of dislocation of the stent to the bladder were observed. Acute urinary toxicity based on IPSS was comparable to toxicity in patients who had gold markers (GM) as fiducials. Removal of the stent was associated with a high frequency of urinary retention. Late GI and GU toxicity and BF were comparable to those of other studies, but longer observation time is needed. This study reports the first clinical results of using a prostate stent as fiducial. No migration of the stent observed. Dislocation of the stent to the urinary bladder was observed in three cases, requiring removal of the stent and insertion of a new fiducial. Acute toxicity during radiotherapy evaluated from IPSS was comparable to toxicity in patients with GM. Removal of the stent was associated with a high frequency of post procedural urinary retention. Late toxicity and BF were comparable to those of other studies, though longer observation time is needed.

[Elsberg syndrome].

PubMed

Nielsen, Kristine Esbjerg; Knudsen, Troels Bygum

2013-12-16

A syndrome involving acute urinary retention in combination with sacral radiculitis and cerebrospinal fluid pleocytosis was first described by the American neurosurgeon Charles Elsberg in 1931. In many instances the aetiology is herpes simplex virus type 2 (HSV-2) reactivation from sensory neurons. In this case report we present a 34-year-old pregnant woman with previous undiagnosed sensory lumbosacral symptoms. She was hospitalized with HSV-2 meningitis and lumbosacral radiculitis but no genital rash. A week after the onset of symptoms she developed acute urinary retention, thus indicating Elsberg syndrome.

Urinary retention, erectile dysfunction and meningitis due to sacral herpes zoster: a case report and review of the literature.

PubMed

Erol, B; Avci, A; Eken, C; Ozgok, Y

2009-01-01

Zona zoster infection is often associated with painful erythematous vesicular eruptions of the skin or mucous membranes. Varicella zoster virus which stays latent in the sensorial root ganglia causes zona zoster infection. The most recognized feature of zona zoster is the dermatomal distribution of vesicular rashes. In the present case report, we state an unusual presentation of sacral zona zoster with urinary retention, erectile dysfunction and meningitis. Copyright 2009 S. Karger AG, Basel.

Clinical, Laboratorial, and Urodynamic Findings of Prostatic Artery Embolization for the Treatment of Urinary Retention Related to Benign Prostatic Hyperplasia. A Prospective Single-Center Pilot Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Antunes, Alberto A.; Carnevale, Francisco C., E-mail: fcarnevale@uol.com.br; Motta Leal Filho, Joaquim M. da

2013-08-01

PurposeThis study was designed to describe the clinical, laboratorial, and urodynamic findings of prostatic artery embolization (PAE) in patients with urinary retention due to benign prostatic hyperplasia (BPH).MethodsA prospective study of 11 patients with urinary retention due to BPH was conducted. Patients underwent physical examination, prostate specific antigen (PSA) measurement, transrectal ultrasound, and magnetic resonance imaging. International prostate symptom score (IPSS), quality of life (QoL), and urodynamic testing were used to assess the outcome before and after 1 year.ResultsClinical success was 91 % (10/11 patients) with a mean follow-up of 22.3 months (range, 12-41 months). At the first year follow-up,more » the mean IPSS score was 2.8 points (p = 0.04), mean QoL was 0.4 points (p = 0.001), mean PSA decreased from 10.1 to 4.3 ng/mL (p = 0.003), maximum urinary flow (Qmax) improved from 4.2 to 10.8 mL/sec (p = 0.009), and detrusor pressure (Pdet) decreased from 85.7 to 51.5 cm H{sub 2}O (p = 0.007). Before PAE, Bladder Outlet Obstruction Index (BOOI) showed values >40 in 100 % of patients. After PAE, 30 % of patients were >40 (obstructed), 40 % were between 20 and 40 (undetermined), and 30 % were <20 (unobstructed). Patients with a BOOI <20 had higher PSA values at 1-day after PAE.ConclusionsClinical and urodynamic parameters improved significantly after PAE in patients with acute urinary retention due to BPH. Total PSA at day 1 after PAE was higher in patients with unobstructed values in pressure flow studies.« less

Experimental results on mechanisms of action of electrical neuromodulation in chronic urinary retention.

PubMed

Schultz-Lampel, D; Jiang, C; Lindström, S; Thüroff, J W

1998-01-01

Sacral foramen neuromodulation--initially applied for the treatment of urinary incontinence--has proved to be effective in patients with chronic urinary retention. Thus far, the underlying neurophysiological mechanisms have not been elucidated. In an experimental study on the neurophysiological basis of sacral neurostimulation, one objective was to investigate the mechanisms responsible for initiation of micturition in chronic urinary retention. In ten female cats anesthetized with alpha-chloralose the clinical situation of sacral foramen stimulation was experimentally reproduced by isolated S2 nerve stimulation after L6-S3 laminectomy. Stimulation responses were recorded from the bladder, peripheral nerves, and striated muscles of the foot and pelvic floor. The effect of sudden cessation of prolonged S2 stimulation, during which the bladder was completely inhibited, was evaluated in 70 stimulation sequences in 5 cats. Sacral nerve stimulation induced excitatory and inhibitory effects on the bladder, depending on the frequency and intensity of stimulation. With unilateral S2 stimulation, bladder excitation was best at frequencies of 2-5 Hz and at intensities ranging between 0.8 and 1.4 times the threshold for the M-response of the foot muscle. Inhibition was the dominating effect at frequencies of 7-10 Hz and at intensities exceeding 1.4 times the threshold. Prolonged S2 stimulation above the threshold produced complete bladder inhibition during stimulation but induced strong bladder contractions after sudden interruption of stimulation, with amplitudes being significantly higher than that of spontaneous contractions preceding the stimulation. These results confirm the hypothesis of a "rebound" phenomenon as the mechanism of action for induction of spontaneous voiding in patients with chronic urinary retention.

The neurophysiology of urinary retention in young women and its treatment by neuromodulation.

PubMed

Goodwin, R J; Swinn, M J; Fowler, C J

1998-01-01

Urinary retention occurring in young women as an isolated phenomenon was often thought to be psychogenic in origin. However, in 1988, Fowler et al. described a syndrome in young women in which urinary retention was the predominant feature and in which electromyography (EMG) of the striated urethral sphincter revealed a striking abnormality. This abnormality, it was postulated, would result in an inability of the sphincter to relax and retention would therefore result. Until recently there was no effective treatment for this disorder except management by clean intermittent self-catheterisation. However, preliminary results of neuromodulation using a Medtronic sacral nerve stimulator have been particularly promising in this group of patients. The response is often spectacular; a woman who has not passed urine per urethram for many months or years will frequently find that within a few hours of insertion of the percutaneous nerve evaluation (PNE) lead, she can void quite normally with little or no residual urine. The precise mechanism of action is yet to be defined, but measurements of the latency of anal sphincter contraction on S3 stimulation during PNE are so prolonged that they can only be the result of an afferent-mediated reflex.

Management of the complications of BPH/BOO.

PubMed

Speakman, Mark J; Cheng, Xi

2014-04-01

Most men will develop histological BPH if they live long enough. Approximately, half will develop benign prostatic enlargement (BPE) and about half of these will get BOO with high bladder pressures and low flow, this in turn leads to detrusor wall hypertrophy. Many of these men will only have lower urinary tract symptoms (LUTS) but a significant number will also suffer the other complications of BPH. These include urinary retention (acute and chronic), haematuria, urinary tract infection, bladder stones, bladder wall damage, renal dysfunction, incontinence and erectile dysfunction. Recognition of the complications of BPH/BOO early allows more effective management of these complications. This is particularly important for the more serious urinary infections and also for high-pressure chronic retention (HPCR). Complications of LUTS/BPH are very rare in clinical trials because of their strict inclusion and exclusion criteria but are more common in real life practice.

[Sacral nerve stimulation in the treatment of the lower urinary tract function disorders].

PubMed

Miotła, Paweł; Kulik-Rechberger, Beata; Skorupski, Paweł; Rechberger, Tomasz

2011-11-01

Functional disorders of the female lower urinary tract like urge incontinence, idiopathic urinary retention and symptoms of urgency-frequency occasionally do not respond properly to classical behavioral and pharmacological therapy Therefore, additional alternative therapies are needed to alleviate these bothersome symptoms. Sacral neuromodulation (SNS) utilize mild electrical pulses which activate or suppress neural reflexes responsible for voiding by stimulating the sacral nerves that innervate the bladder, external urethral sphincter and pelvic floor muscles. The exact mechanism of SNS action is not yet fully understood but it is assumed that it influences the neuroaxis at different levels of the central nervous system and restores the balance between inhibitory and activatory control over the voiding reflex. There is numerous evidence on the success of SNS not only in the treatment of refractory urge incontinence in adult and children but also in idiopathic urinary retention and symptoms of urgency-frequency

A combination of a dairy product fermented by lactobacilli and galactooligosaccharides shows additive effects on mineral balances in growing rats with hypochlorhydria induced by a proton pump inhibitor.

PubMed

Takasugi, Satoshi; Ashida, Kinya; Maruyama, Suyaka; Matsukiyo, Yukari; Kaneko, Tetsuo; Yamaji, Taketo

2013-06-01

This study aimed to investigate the effects of a combination of a dairy product fermented by lactobacilli (DFL) and galactooligosaccharides (GOS) on mineral balances in growing rats with hypochlorhydria induced by a proton pump inhibitor (PPI). Three-week-old male rats were assigned to receive one of six diets: a control diet, control diets containing 1.6 or 5.0 % GOS, a DFL diet and DFL diets containing 1.6 or 5.0 % GOS for 9 days. From day 5 of the feeding period, half of the rats fed with control diets were subcutaneously administered with saline, whereas the remaining rats were administered with PPI for 5 days. Calcium (Ca), phosphorus (P), magnesium (Mg), iron (Fe) and zinc (Zn) balances were determined from days 6 to 9. PPI administration significantly decreased the apparent absorption of Ca and Fe and increased urinary P excretion, resulting in decreased Ca, Fe and P retention. GOS dose-dependently increased the apparent absorption of Ca, Mg and Fe and urinary Mg excretion and decreased urinary P excretion. DFL significantly increased the apparent absorption of Ca and Mg and urinary Mg excretion. The combination of DFL and GOS additively affected these parameters, resulting in increased Ca, P and Fe retention, and it further increased the apparent absorption and retention of Zn at 5.0 % GOS. In conclusion, the combination of DFL and GOS improves Ca, P and Fe retention in an additive manner and increases the Zn retention in growing rats with hypochlorhydria induced by PPI.

[A case of hyperammonemia resulting from urinary tract infection caused by urease-producing bacteria in a Parkinson's disease patient with drug-induced urinary retention].

PubMed

Yasunishi, Masahiro; Koumura, Akihiro; Hayashi, Yuichi; Nishida, Shohei; Inuzuka, Takashi

2017-01-01

A 71-year-old woman with a 9-year history of Parkinson's disease was admitted to our hospital emergently because of consciousness disturbance. Her consciousness level was 200 on the Japan coma scale (JCS), and she presented with tenderness and distension of the lower abdomen. Brain computed tomography showed normal findings. Blood tests showed an increased ammonia level (209 μg/dl) with normal AST and ALT levels. We catheterized the bladder for urinary retention. Five hours after admission, the blood ammonia level decreased to 38 μg/dl, and her consciousness level improved dramatically. Corynebacterium urearyticum, a bacterial species that produces urease, was detected by urine culture. Therefore, she was diagnosed with hyperammonemic encephalopathy resulting from urinary tract infection caused by urease-producing bacteria. In this case, urologic active agents had been administered to treat neurogenic bladder. We suspect that these drugs caused urinary obstruction and urinary tract infection. It is important to recognize that obstructive urinary tract infection caused by urease-producing bacteria can cause hyperammonemia. Neurological disorders, such as Parkinson's disease, tend to complicate neurogenic bladder. This disease should be considered in elderly patients with Parkinson's disease who are receiving urologic active drugs.

Combining Ketamine and Virtual Reality Pain Control During Severe Burn Wound Care: One Military and One Civilian Patient

DTIC Science & Technology

2011-01-01

effects include nausea/ vomiting, constipation , sedation, interference with sleep cycles, increased irritability, itching, urinary retention, cog...Xia J, Hailan W. Ketamine and lornoxicam for preventing a fentanyl-induced increase in postoperative morphine requirement. Anesth Analg 2008;107(6...verbal pain descriptors. Pain 1978;5:5–18. 30 Hoffman HG, Patterson DR, Magula J, et al. Water - friendly virtual reality pain control during wound

Complications following prostate needle biopsy requiring hospital admission or emergency department visits - experience from 1000 consecutive cases.

PubMed

Pinkhasov, G Igor; Lin, Yu-Kuan; Palmerola, Ricardo; Smith, Paul; Mahon, Frank; Kaag, Matthew G; Dagen, J Edward; Harpster, Lewis E; Reese, Carl T; Raman, Jay D

2012-08-01

• To review a contemporary cohort of patients undergoing a transrectal ultrasound-guided prostate needle biopsy (TRUS PNBx) at a single centre to determine the incidence of major complications necessitating hospital admission or emergency department (ED) visits. • The charts of 1000 consecutive patients undergoing TRUS PNBx were reviewed. • All patients received peri-procedural antibiotic prophylaxis with either ciprofloxacin or co-trimoxazole. • Hospital admission and ED visits within 30 days of the procedure were identified for indication, management and outcome. • Patient comorbidities and biopsy characteristics were reviewed for association with complications. • Of the 1000 patients, 25 (2.5%) had post-biopsy complications requiring hospital admission or an ED visit. • Indications included twelve patients (1.2%) with urosepsis, eight (0.8%) with acute urinary retention requiring urethral catheterization, four (0.4%) with gross haematuria requiring bladder irrigation for <24 h, and one (0.1%) with a transient ischaemia attack 1 day after biopsy. • Patients with urosepsis had an average hospitalization of 5 days, and 75% carried quinolone-resistant Escherichia coli organisms. • All patients with urinary retention had catheters removed within 10 days. No patients with haematuria required a blood transfusion. • No demographic or biopsy variables were particularly associated with development of a post-procedure complication. • In this large contemporary series of TRUS PNBx, we observed a 2.5% rate of major complications requiring hospital admission or an ED visit. • No clinical or biopsy variables were directly associated with development of complications. • These data may be valuable when counselling patients before biopsy. © 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.

Retention of urine and sacral paraesthesia in anogenital herpes simplex infection.

PubMed

Edis, R H

1981-01-01

Two definite and 2 probable cases of anogenital herpes simplex and sacral radiculitis are described. Symptoms were typical and consisted of paraesthesia and neuralgic pain in the perineum and legs, urinary retention and constipation occurring within several days to a week after an anogenital herpetic eruption. However, at presentation only 1 case had an obvious history of anogenital herpes simplex. Neurological signs were not striking and consisted of a reduced appreciation of light touch and pin prick over the sacral dermatomes and in 2 cases reduced anal sphincter tone. CSF examination in 3 patients showed a lymphocytosis. Bladder catheterisation was required for up to 2 weeks in 2 patients. The paraesthesia persisted for weeks to months. It should be more widely recognised that anogenital herpes simplex, with sacral radiculitis, is probably the commonest cause of acute retention of urine in young sexually active people.

Calciuric effects of short-term dietary loading of protein, sodium chloride and potassium citrate in prepubescent girls.

PubMed

Duff, T L; Whiting, S J

1998-04-01

Studies using adult human subjects indicate that dietary protein and sodium chloride have negative effects on the retention of calcium by increasing urinary calcium excretion, while alkaline potassium improves calcium retention along with decreasing urinary calcium losses. This study investigated the effect of these dietary factors on acute urinary calcium excretion in 14 prepubescent girls age 6.7 to 10.0 years. Subjects provided a fasting urine sample then consumed a meal containing one of five treatments: moderate protein (MP) providing 11.8 g protein, moderate protein plus 26 mmol sodium chloride (MP+Na), high protein (HP) providing 28.8 g protein, high protein plus 26 mmol sodium chloride (HP+Na), or high protein plus 32 mmol potassium as tripotassium citrate (HP+K). Urine was collected at 1.5 and 3.0 hours after the meal. Supplemental protein was given as 80:20 casein:lactalbumin. Test meals were isocaloric, and unless intentionally altered, components of interest except phosphate were equal between treatments. Each subject completed all five treatments. Urinary calcium excretion rose after the meal, peaking at 1.5 hours. There were no significant differences in calcium excretion between treatments at any time point. The high protein treatments did not result in a significant increase in either net acid or sulfate excretion at 1.5 hours compared to moderate protein. Dietary sodium chloride had no effect on urinary sodium or calcium excretion over the 3 hours. After the potassium treatment, sodium excretion increased (p< or =0.002) and net acid excretion decreased (p<0.001) compared to other treatments at 1.5 hours. In children, a simultaneous increase in protein and phosphorus due to increased milk protein intake did not increase acute urinary calcium excretion. An effect of dietary sodium chloride on acute urinary calcium excretion was not observed. Both these findings were similar to those of adult studies previously conducted in the same laboratory using similar format and treatments. Potassium citrate was not hypocalciuric in children, a response differing from that for adults, who have shown a decrease in acute urinary calcium excretion in response to alkaline potassium treatment. Further characterization of calciuric responses to dietary factors is required for children, who may differ from adults in many respects.

[Urinary tract dysfunction in older patients].

PubMed

Verdejo, Carlos; Méndez, Santiago; Salinas, Jesús

2016-11-18

Urinary tract dysfunction in older patients has a multifactorial aetiology and is not a uniform clinical condition. Changes due to physiological ageing as well as comorbidity and polypharmacy, can produce several dynamic conditions such as urinary incontinence and urinary retention. Lower urinary tract symptoms increase with age in both sexes and are a major problem in older patients due to their medical and psychosocial consequences. For these reasons, in assessing urinary dysfunction in older patients, we should consider external circumstances such as polypharmacy, poor mobility, affective and cognitive disorders and also accessibility to housing. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

[Hospitalization rate in relation to severe complications of transrectal prostate biopsy: About 2715 patients biopsied].

PubMed

Tamarelle, B; Perrin, P; Devonec, M; Paparel, P; Ruffion, A

To identify hospitalizations directly related to a complication occurring within 30 days following a transrectal prostate biopsy (PBP). Overall hospitalization rates, mortality rates, potential predisposing factors for complications. Single-center study including all patients who underwent PBP between January 2005 and January 2012. Any hospitalization occurring within 30 days of the PBP for urgent motive was considered potentially attributable to biopsy. We identified the reason for hospitalization with direct complications (urinary infection or fever, rectal bleeding, bladder caillotage, retention) and indirect (underlying comorbidities decompensation) of the biopsy. The contributing factors were anticoagulant or antiplatelet treatment well as waning immunity factors (corticosteroid therapy, HIV, chemotherapy or immunodulateur). Among 2715 men who underwent PBP, there were 120 (4.4%) hospitalizations including 28 (1.03%) caused by the biopsy. Twenty-five (0.92%) were related to a direct complication of biopsy: 14 (56%) for urinary tract infection or fever including 1 hospitalization in intensive care, 5 (20%) for rectal bleeding which required several transfusions 1, 10 (40%) urinary retention and 3 (0.11%) for an indirect complication (2 coronary syndromes and 1 respiratory failure). Several direct complications were associated in 3 cases. Only two hospitalizations associated with rectal bleeding were taking an antiplatelet or anticoagulant. There was no association between hospitalization for urinary tract infections and a decreased immune status. The first death observed in our study occurred at D31 of pulmonary embolism (advanced metastatic patient with bladder cancer). Twenty (60.6%) patients urgently hospitalized did not have prostate cancer. Within this large sample of patients the overall rate of hospitalization due to the realization of a PBP was 1%. It has not been found predictive of complications leading to hospitalization. 4. Copyright © 2016. Published by Elsevier Masson SAS.

Herpes zoster-associated voiding dysfunction in hematopoietic malignancy patients.

PubMed

Imafuku, Shinichi; Takahara, Masakazu; Uenotsuchi, Takeshi; Iwato, Koji; Furue, Masutaka

2008-01-01

Voiding dysfunction is a rare but important complication of lumbo-sacral herpes zoster. Although the symptoms are transient, the clinical impact on immunocompromised patients cannot be overlooked. To clarify the time course of voiding dysfunction in herpes zoster, 13 herpes zoster patients with voiding dysfunction were retrospectively analyzed. Of 13 patients, 12 had background disease, and six of these were hematopoietic malignancies; four of these patients were hematopoietic stem cell transplant (HSCT) recipients. Ten patients had sacral lesions, two had lumbar, and one had thoracic lesions. Interestingly, patients with severe rash, or with hematopoietic malignancy had later onset of urinary retention than did patients with mild skin symptoms (Mann-Whitney U analysis, P = 0.053) or with other background disease (P = 0.0082). Patients with severe skin rash also had longer durations (P = 0.035). In one case, acute urinary retention occurred as late as 19 days after the onset of skin rash. In immune compromised subjects, attention should be paid to patients with herpes zoster in the lumbo-sacral area for late onset of acute urinary retention even after the resolution of skin symptoms.

[The profile urological emergencies at the Conakry University Teaching Hospital, Guinea].

PubMed

Bobo Diallo, A; Bah, I; Diallo, T M O; Bah, O R; Amougou, B; Bah, M D; Guirassy, S; Bobo Diallo, M

2010-03-01

To stick out the profile urological emergencies at the Conakry University Teaching Hospital, Guinea. This retrospective study, carried out over a period of 3 years (January 2005-December 2007), included 757 urological emergencies admitted to the urology department of the university hospital of Conakry, Guinea. The mean age of patients was 56 years. These patients had an age equal to or higher than 60 years in 58% of the cases. The sex ratio (M/F) was 16.6. According to the social profession, the farmer (40,6%) and workers (21%) were the dominant patients. The most frequent illness was vesical urinary retention (73.9%), hematuria (9.6%) and genito-urinary system trauma (7%). The most performed procedures were the installation of a urethral catheter (55.25%) and the installation of a suprapubic catheter (24.14%). The most frequent urological emergency in our country was vesical urinary retention, the hematuria and genito-urinary system trauma are not rare there. Copyright 2009 Elsevier Masson SAS. All rights reserved.

Quantification of urinary zwitterionic organic acids using weak-anion exchange chromatography with tandem MS detection.

PubMed

Bishop, Michael Jason; Crow, Brian S; Kovalcik, Kasey D; George, Joe; Bralley, James A

2007-04-01

A rapid and accurate quantitative method was developed and validated for the analysis of four urinary organic acids with nitrogen containing functional groups, formiminoglutamic acid (FIGLU), pyroglutamic acid (PYRGLU), 5-hydroxyindoleacetic acid (5-HIAA), and 2-methylhippuric acid (2-METHIP) by liquid chromatography tandem mass spectrometry (LC/MS/MS). The chromatography was developed using a weak anion-exchange amino column that provided mixed-mode retention of the analytes. The elution gradient relied on changes in mobile phase pH over a concave gradient, without the use of counter-ions or concentrated salt buffers. A simple sample preparation was used, only requiring the dilution of urine prior to instrumental analysis. The method was validated based on linearity (r2>or=0.995), accuracy (85-115%), precision (C.V.<12%), sample preparation stability (

Study comparing 3 hour and 24 hour post-operative removal of bladder catheter and vaginal pack following vaginal surgery: a randomised controlled trial.

PubMed

Rajan, Priya; Soundara Raghavan, S; Sharma, Deepak

2017-09-11

Traditional practice after vaginal hysterectomy was to keep the vaginal pack and urinary catheter for 24 hours post operatively. But there were studies that prolonged cathterisation was associated with urinary infection. So this study was conducted to compare the post operative outcome when the urinary catheter and vaginal pack were removed after 3 hours and after 24 hours after surgery. The study was done in the Department of Obstetrics and Gynecology, in a tertiary teaching institute of South India from September 2008 to March 2010. It was a randomised controlled trial involving 200 women undergoing vaginal surgery, who were randomly assigned to 2 groups - catheter and vaginal pack were removed either in 3 h in study group or were removed in 24 h in control group. The outcome of the study were vaginal bleeding, urinary retention, febrile morbidity, and urinary infection. There was no significant difference between the study and control groups with respect to vaginal bleeding (0 and 1%, p = 1), urinary retention (9 and 4%, p = 0.15), febrile morbidity (7 and 4%, p = 0.35), and urinary infection (26% in each group, p = 1.0). Keeping the urinary catheter and vaginal pack for 24 h following vaginal surgery does not offer any additional benefit against removing them after 3 h.

Genetic and Epigenetic Biomarkers for Recurrent Prostate Cancer After Radiotherapy

DTIC Science & Technology

2013-05-01

prostatectomy are urinary incontinence , erectile dysfunction, and typical post-operative complications. Radiation therapy (RT) shows several distinct...includes a low risk of urinary incontinence . Major disadvantage of external beam RT include a treatment course of 8-9 weeks. -50% of patients have some...this treatment include the risk of acute urinary retention. Currently, the level of PSA, clinical stage and the Gleason score are used to

[Evaluation of the activity of a urological emergency unit in university hospital].

PubMed

Martin, L; Pillot, P; Bardonnaud, N; Lillaz, J; Chabannes, E; Bernardini, S; Guichard, G; Bittard, H; Kleinclauss, F

2014-01-01

To determine the epidemiology of urological emergencies in a university hospital and the interest of a dedicated urological emergency unit. In 2008, a dedicated urological emergency unit was individualized in our department of urology. We conducted a retrospective study including all patients consulting in this unit in 2009 with epidemiological, clinical and therapeutic data. During 2009, 1257 patients consulted in this unit. Main diagnoses were acute urinary retention (303, 24.11%), renal colic (219, 17.42%), urinary infections (278, 22.11%), postoperative complications (141, 11.22%), symptomatic benign prostate hyperplasia (65, 5.17%), genitourinary cancers (61, 4.85%), trauma of urinary apparel (41, 3.26%), and spermatic cords torsion (10, 0.8%). In 99 cases (7.88%) diagnosis did not involved the urinary system. The treatment was surgical in 213 (17.7%) cases, technical procedure under local anesthesia in 368 (29.3%) and a medical treatment in 675 (53.7%) cases. Six hundred and sixty (52.5%) patients were managed ambulatory whereas 596 (47.5%) needed hospitalization. The opening of a dedicated urological emergency unit lead to 1257 emergency consultations. Frequent etiologies were acute urinary retention, renal colic and urinary infection. The creation of this unit allowed to register and to valorize this emergency activity through the ATU emergency amount. Copyright © 2013. Published by Elsevier Masson SAS.

Uterine rupture disguised by urinary retention following a second trimester induced abortion: a case report.

PubMed

Jiang, Qiaoying; Yang, Liwei; Ashley, Charles; Medlin, Erin E; Kushner, David M; Zheng, Yanmei

2015-01-22

Uterine rupture classically presents with severe abdominal pain, loss of fetal station, vaginal bleeding, and shock. We present a case of uterine rupture presenting as significant urinary retention that occurred following a second trimester abortion induced with mifepristone and misoprostol. Uterine rupture was discovered unexpectedly on diagnostic laparoscopy. The uterine rupture was contained by dense adhesions between the omentum and bladder with the previous uterine cesarean hysterotomy scar. This case highlights the difficulties in diagnosis of abnormal placentation and an unusual presentation of uterine rupture. This case was managed successfully laparoscopically.

Postoperative urinary retention after inguinal hernia repair: a single institution experience.

PubMed

Blair, A B; Dwarakanath, A; Mehta, A; Liang, H; Hui, X; Wyman, C; Ouanes, J P P; Nguyen, H T

2017-12-01

Inguinal hernia repair is a common general surgery procedure with low morbidity. However, postoperative urinary retention (PUR) occurs in up to 22% of patients, resulting in further extraneous treatments.This single institution series investigates whether patient comorbidities, surgical approaches, and anesthesia methods are associated with developing PUR after inguinal hernia repairs. This is a single institution retrospective review of inguinal hernia from 2012 to 2015. PUR was defined as patients without a postoperative urinary catheter who subsequently required bladder decompression due to an inability to void. Univariate and multivariate logistic regressions were performed to quantify the associations between patient, surgical, and anesthetic factors with PUR. Stratification analysis was conducted at age of 50 years. 445 patients were included (42.9% laparoscopic and 57.1% open). Overall rate of PUR was 11.2% (12% laparoscopic, 10.6% open, and p = 0.64). In univariate analysis, PUR was significantly associated with patient age >50 and history of benign prostatic hyperplasia (BPH). Risk stratification for age >50 revealed in this cohort a 2.49 times increased PUR risk with lack of intraoperative bladder decompression (p = 0.013). At our institution, we found that patient age, history of BPH, and bilateral repair were associated with PUR after inguinal hernia repair. No association was found with PUR and laparoscopic vs open approach. Older males may be at higher risk without intraoperative bladder decompression, and therefore, catheter placement should be considered in this population, regardless of surgical approach.

Role of pelvic floor in lower urinary tract function.

PubMed

Chermansky, Christopher J; Moalli, Pamela A

2016-10-01

The pelvic floor plays an integral part in lower urinary tract storage and evacuation. Normal urine storage necessitates that continence be maintained with normal urethral closure and urethral support. The endopelvic fascia of the anterior vaginal wall, its connections to the arcus tendineous fascia pelvis (ATFP), and the medial portion of the levator ani muscles must remain intact to provide normal urethral support. Thus, normal pelvic floor function is required for urine storage. Normal urine evacuation involves a series of coordinated events, the first of which involves complete relaxation of the external urethral sphincter and levator ani muscles. Acquired dysfunction of these muscles will initially result in sensory urgency and detrusor overactivity; however, with time the acquired voiding dysfunction can result in intermittent urine flow and incomplete bladder emptying, progressing to urinary retention in severe cases. This review will start with a discussion of normal pelvic floor anatomy and function. Next various injuries to the pelvic floor will be reviewed. The dysfunctional pelvic floor will be covered subsequently, with a focus on levator ani spasticity and stress urinary incontinence (SUI). Finally, future research directions of the interaction between the pelvic floor and lower urinary tract function will be discussed. Copyright © 2015 Elsevier B.V. All rights reserved.

Longitudinal Association between Prostatitis and Development of Benign Prostatic Hyperplasia

PubMed Central

St. Sauver, Jennifer L.; Jacobson, Debra J.; McGree, Michaela E.; Girman, Cynthia J.; Lieber, Michael M.; Jacobsen, Steven J.

2008-01-01

OBJECTIVES To determine whether physician-diagnosed prostatitis was associated with later development of development of BPH-associated events in a longitudinal, population-based sample of 2447 men residing in Olmsted County, Minnesota. METHODS Medical records were reviewed for physician diagnosis of prostatitis and subsequent diagnoses of BPH, enlarged prostate, prostatism, and acute urinary retention. Records were also reviewed for medical or surgical treatments for BPH. Odds ratios were calculated to assess the associations between physician-diagnosed prostatitis and later development of development of BPH-associated events. RESULTS Physician-diagnosed prostatitis was associated with a 2.4-fold increased odds of receiving a later diagnosis of prostatism, enlarged prostate, or BPH (OR: 2.44, 95% CI: 1.48, 4.01). Prostatitis was also associated with a 70% increased odds of requiring later treatment for BPH (OR: 1.69, 95% CI: 1.28, 2.22), and a non-significant increased odds of acute urinary retention (OR: 1.33, 95% CI: 0.89, 1.99). CONCLUSIONS Physician-diagnosed prostatitis was associated with an increased risk of later onset of several BPH-associated events. Physician-diagnosed prostatitis may therefore be an early marker or a risk factor for development of later prostatic or urologic problems. PMID:18342190

Life-threatening urethral hemorrhage after placement of a Foley catheter in a patient with uroseptic disseminated intravascular coagulation due to chronic urinary retention induced by untreated benign prostatic hyperplasia.

PubMed

Ikegami, Yukihiro; Yoshida, Keisuke; Imaizumi, Tsuyoshi; Isosu, Tsuyoshi; Kurosawa, Shin; Murakawa, Masahiro

2016-10-01

A 77-year-old man with severe septic disseminated intravascular coagulation following urinary infection was transported to our hospital. He had developed urinary retention induced by untreated prostatic hyperplasia. Immediate drainage with a Foley catheter was successfully carried out, but the hematuria progressed to life-threatening hemorrhage. Complete hemostasis was impossible by surgical treatment because the tissue around the prostatic urethra was very fragile and hemorrhagic. Organized treatments (continuous hemodiafiltration combined with polymyxin-B immobilized fiber column hemoperfusion and systemic treatment with antibiotics and coagulation factors) were commenced soon after the operation. The patient eventually recovered from the septic disseminated intravascular coagulation. This case report illustrates the risk of placement of Foley catheters in patients with severe septic disseminated intravascular coagulation.

Pelvic plexus compression due to a uterine leiomyoma in a woman with acute urinary retention: a new hypothesis.

PubMed

Andrada, Andrea Orosa; De Vicente, José Miguel Gómez; Cidre, Miguel Angel Jiménez

2014-03-01

Acute urinary retention (AUR) in women is an uncommon occurrence described by the International Continence Society (ICS) as a painful, palpable, or perceptible bladder when the patient is unable to pass urine. Contrarily to men, AUR in women is not usually due to any obstructive process. Neurologic causes are the most common reason for AUR in reproductive-age women. A few case reports have been published concerning women suffering from gynecological pathology and AUR, and they propose extrinsic compression of the urinary tract. In the case we report, AUR pathophysiology was compression of the pelvic plexus by a giant uterine leiomyoma. An electromyogram displayed motor polyradiculopathy of S1 and S2 nerve roots, and the patient was unable to urinate due to an uncontractible bladder.

Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.

PubMed

Sakakibara, Ryuji; Uchiyama, Tomoyuki; Kuwabara, Satoshi; Mori, Masahiro; Ito, Takashi; Yamamoto, Tatsuya; Awa, Yusuke; Yamaguchi, Chiharu; Yuki, Nobuhiro; Vernino, Steven; Kishi, Masahiko; Shirai, Kohji

2009-01-01

To examine the prevalence and mechanism of urinary dysfunction in GBS. Urinary symptoms were observed and neurological examinations made repeatedly during hospitalization of 65 consecutive patients with clinico-neurophysiologically definite GBS. The patients included 41 men, 24 women; mean age, 41 years old; mean Hughes motor grade, 3; AIDP, 28, AMAN, 37. Urodynamic studies consisted of uroflowmetry, measurement of post-micturition residuals, medium-fill water cystometry, and external anal sphincter electromyography. Urinary dysfunction was observed in 27.7% of GBS cases (urinary retention, 9.2%). Urinary dysfunction was related to the Hughes motor grade (P < 0.05), defecatory dysfunction (P < 0.05), age (P < 0.05), and negatively related to serum IgG class anti-ganglioside antibody GalNAc-GD1a (P < 0.05). Urinary dysfunction was more common in AIDP (39%) than in AMAN (19%). No association was found between antibody titer against neuronal nicotinic acetylcholine receptors and urinary dysfunction. Urodynamic studies in nine patients, mostly performed within 8 weeks after disease onset, revealed post-void residual in 3 (mean 195 ml), among those who were able to urinate; decreased bladder sensation in 1; detrusor overactivity in 8; low compliance in 1; underactive detrusor in 7 (both overactive and underactive detrusor in 5); and nonrelaxing sphincter in 2. In our series of GBS cases, 27.7% of the patients had urinary dysfunction, including urinary retention in 9.2%. Underactive detrusor, overactive detrusor, and to a lesser extent, hyperactive sphincter are the major urodynamic abnormalities. The underlying mechanisms of urinary dysfunction appear to involve both hypo- and hyperactive lumbosacral nerves. Neurourol. Urodynam. 28:432-437, 2009. (c) 2009 Wiley-Liss, Inc.

Hematuria and clot retention after transvaginal oocyte aspiration: a case report.

PubMed

Modder, Joshua; Kettel, L Michael; Sakamoto, Kyoko

2006-09-01

To report a case of bladder injury with hematuria and urinary retention after transvaginal oocyte aspiration. Case report. Emergency room in a university medical center. A 28-year-old woman presented with urinary retention and suprapubic pain 8 hours after oocyte aspiration. Foley catheter, intravenous fluid bolus, bladder irrigation, and computed tomography with postvoid films that showed a blood clot in the bladder. Patient was discharged home with antibiotics and catheter in place. Clinical follow-up. Patient passed voiding trial 4 days later and was artificially inseminated. No further hematuria or voiding problems were reported, and she had a successful pregnancy. Patients who elect to undergo oocyte aspiration should be warned about the possibility of bladder injury because of the close proximity of the ovaries to the bladder, and physicians should have an appropriate treatment plan.

Systematic review and meta-analysis of continuous local anaesthetic wound infiltration versus epidural analgesia for postoperative pain following abdominal surgery.

PubMed

Ventham, N T; Hughes, M; O'Neill, S; Johns, N; Brady, R R; Wigmore, S J

2013-09-01

Local anaesthetic wound infiltration techniques reduce opiate requirements and pain scores. Wound catheters have been introduced to increase the duration of action of local anaesthetic by continuous infusion. The aim was to compare these infiltration techniques with the current standard of epidural analgesia. A meta-analysis of randomized clinical trials (RCTs) evaluating wound infiltration versus epidural analgesia in abdominal surgery was performed. The primary outcome was pain score at rest after 24 h on a numerical rating scale. Secondary outcomes were pain scores at rest at 48 h, and on movement at 24 and 48 h, with subgroup analysis according to incision type and administration regimen(continuous versus bolus), opiate requirements, nausea and vomiting, urinary retention, catheter-related complications and treatment failure. Nine RCTs with a total of 505 patients were included. No differences in pain scores at rest 24 h after surgery were detected between epidural and wound infiltration. There were no significant differences in pain score at rest after 48 h, or on movement at 24 or 48 h after surgery. Epidural analgesia demonstrated a non-significant a trend towards reduced pain scores on movement and reduced opiate requirements. There was a reduced incidence of urinary retention in the wound catheter group. Within a heterogeneous group of RCTs, use of local anaesthetic wound infiltration was associated with pain scores comparable to those obtained with epidural analgesia. Further procedure-specific RCTs including broader measures of recovery are recommended to compare the overall efficacy of epidural and wound infiltration analgesic techniques.

KTP laser selective vaporization of the prostate in the management of urinary retention due to BPH

NASA Astrophysics Data System (ADS)

Kleeman, M. W.; Nseyo, Unyime O.

2003-06-01

High-powered photoselective vaporization of the prostate (PVP) is a relatively new addition in the armamentarium against bladder outlet obstruction due to BPH. With BPH, the prostate undergoes stromal and epithelial hyperplasia, particularly in the transitional zone, mediated by dihydrotestosterone (DHT). This periurethral enlargement can compress the prostatic urethra leading to bladder outlet obstruction and eventually urinary retention. Treatment of uncomplicated symptomatic BPH has evolved from the standard transurethral resection of the prostate (TURP) to multiple medical therapies and the putative minimally invasive surgical procedures. These include microwave ablation, needle ablation, balloon dilation, stents, as well as fluid based thermo-therapy, ultrasound therapy and cryotherapy. Different forms of lasers have been applied to treat BPH with variable short and long term benefits of urinary symptoms. However, the controversy remains about each laser regarding its technical applicability and efficacy.

[Four cases of urinary dysfunction associated with sacral herpes zoster].

PubMed

Matsuo, Tomohiro; Oba, Kojiro; Miyata, Yasuyoshi; Igawa, Tsukasa; Sakai, Hideki

2014-02-01

Herpes zoster is caused by the infection of Varicella-Zoster virus. The anatomical distribution of herpes zoster in the sacral area is only 6. 9%1). Moreover, the onset rate of herpes zoster with urinary dysfunction is 0.6%1). The lesion sites of herpes zoster which cause urinary dysfunction are almost lumber and sacral areas. We describe four cases of sacral herpes zoster with urinary dysfunction in this report. All patients were elderly people (66-84 years old), and all patients were administered anti-virus drugs and alpha 1-adrenergic receptor blockers. Because of urinary retention, three patients have performed clean intermittent self-catheterization (CIC) for several weeks. As the lesions of herpes zoster healed, each patient recovered from urinary dysfunction.

How Hugh Hampton Young's treatment of President Woodrow Wilson's urinary retention and urosepsis affected the resolution of World War I.

PubMed

Fogg, Ryan; Kutikov, Alexander; Uzzo, Robert G; Canter, Daniel

2011-09-01

President Woodrow Wilson was never able to gain ratification of the Treaty of Versailles, the peace accord to end World War I. Before he could convince the American people of the importance of ratification, Wilson suffered a stroke followed by life threatening urinary sepsis due to urinary retention, and was treated by the father of modern urology, Hugh Hampton Young. The effects of these health problems are examined in the context of their implications on international affairs. Biographical sources and primary documentation of Wilson's physicians were reviewed to determine the effect of Wilson's stroke on his voiding habits. Hugh Hampton Young's evaluation and decision making is examined in depth. In the fall of 1919 President Wilson was recovering from a stroke. Shortly after the stroke his preexisting voiding dysfunction progressed to urinary retention from which urinary sepsis developed. Hugh Hampton Young advised on Wilson's case and counseled patience over surgery. The President began voiding spontaneously and recovered from sepsis. The illness left him severely weakened and unable to mount an aggressive campaign to persuade the U.S. Senate of the importance of ratifying the Treaty of Versailles. His personal physician, Admiral Cary T. Grayson, stated that the President was mentally never the same after the sepsis. Wilson's voiding dysfunction contributed to his inability to win approval for the Treaty of Versailles and the League of Nations. As a result, the United States returned to a policy of isolationism and Europe plunged into 2 decades of upheaval, leading to World War II. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Onset of Action of Sacral Neuromodulation in Lower Urinary Tract Dysfunction-What is the Optimal Duration of Test Stimulation?

PubMed

Jairam, Ranjana; Drossaerts, Jamie; Marcelissen, Tom; van Koeveringe, Gommert; van Kerrebroeck, Philip

2018-06-01

Since the development of sacral neuromodulation, a large number of patients with lower urinary tract symptoms have been treated with this procedure. A test stimulation is performed prior to implantation. At centers worldwide the duration of this test stimulation varies considerably since it is not certain when the onset of the therapy effect can be expected. The objective of this prospective study was to evaluate the average onset time of sacral neuromodulation in patients with lower urinary tract symptoms. All patients who were eligible for treatment with sacral neuromodulation were asked to participate in this study. A voiding diary was filled out prior to and during test stimulation using an implanted tined lead. Success was defined as a 50% or greater improvement compared to baseline in any of the main complaint parameters. The Mann-Whitney U test was used to compare the mean time to success between patients with overactive bladder syndrome and patients with nonobstructive urinary retention. Of the 45 patients 24 with nonobstructive urinary retention and 21 with overactive bladder syndrome agreed to participate and were included in study. Test stimulation was successful in 29 patients (64%). Mean time to success in all patients was 3.3 days (range 1 to 9). There was no significant difference in mean time to success between cases of overactive bladder syndrome and nonobstructive urinary retention (3.25 and 3.5 days, respectively, p = 0.76). The results imply that a test stimulation of more than 2 weeks is not necessary if a cutoff of 50% or greater improvement is adopted. However, further improvement can be expected with prolonged test stimulation. This might be important since it might have implications for long-term results. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Case series: Bladder clot evacuation using a prostate morcellation device.

PubMed

Doersch, Karen M; Navetta, Andrew F; Bird, Erin T; El Tayeb, Marawan M

2017-07-01

We sought to provide a technical update on the use of a prostate morcellator device (PMD) to manage organized blood clots of the bladder following laser prostatectomy. Herein, we describe our experience in using the Wolf Piranha morcellator in managing organized bladder blood clots supplemented with a retrospective chart review of the patients in whom this procedure was performed. Six patients, all male with a mean age of 75 ± 8.9 years, had organized bladder clots following either holmium laser enucleation or photoselective vaporization of the prostate managed with a PMD. Clots were recognized based on hematuria or urinary retention a median of 3.5 days following the aforementioned procedures. Initial management was attempted with more conservative measures, including a three-way Foley catheter, followed by cystoscopy with an Ellik evacuator, or a glass Tommey syringe. Morcellation times were a mean of 10.2 ± 6.15 minutes (range 2-18). This technique was able to manage clots that were an average of 173.3 ± 115.9 cc in size. The procedure was well-tolerated. No patients experienced intraoperative or morcellator-related complications. Benign prostatic hypertrophy frequently requires surgical endoscopic management and can be complicated by hematuria and bladder blood clot formation. When these clots become organized, this can lead to urinary retention and the required management, evacuation, may be difficult. The use of a Wolf Piranha PMD is a safe, well-tolerated, and effective in evacuating organized blood clots of the bladder.

Laser-induced synlabia, cryptomenorrhea, and urine retention: A case report and literature review

PubMed Central

Fadul-Elahi, Thoraya; Janjua, Nusrat Batool

2017-01-01

Cosmetic laser use has many pros and cons. The worldwide use of laser for body hair removal has led to many medical complications. Unsupervised use of the laser for hair removal in vulva may result in many problems and can merely damage the vulva, although rarely, affecting the body image. This rare and novel case report is a 21 year old virgin who presented with acute urinary retention and cryptomenorrhea due to complete synlabia secondary to unsupervised vulval laser hair removal. The urinary retention was relieved by suprapubic catheterization initially. During examination under anesthesia, the fused labia were separated by a surgical incision with drainage of hematocolpos and then, a Foley's urethral catheter was inserted. She had an uneventful recovery. We report this case to emphasize on the supervised use of laser by trained and qualified personnel for hair removal in vulva to minimize its complications. PMID:29118543

[Urinary functional disorders bound to deep endometriosis and to its treatment: review of the literature].

PubMed

Campin, L; Borghese, B; Marcellin, L; Santulli, P; Bourret, A; Chapron, C

2014-06-01

Lower urinary tract disorders in case of deep endometriosis are common (up to 50% of patients), although often masked by pelvic pain. They result from damage to the pelvic autonomic nervous system by direct infiltration of these structures by endometriotic lesions or surgical trauma (especially in resection of the uterosacral ligaments, rectum or vagina). These are mainly sensory disturbances and bladder voiding dysfunction. They impact quality of life and could be responsible for long-term complications (recurrent urinary tract infections on a persistent residual urine or pelvic floor disorders due to chronic thrusting). It is therefore important to diagnose and treat early these troubles by well-conducted interviews or standardized questionnaires. Different drug treatments have been proposed, such as cholinergics or prokinetics, but their effectiveness has not been demonstrated yet. Neuromodulation of the superior hypogastric plexus for treatment of refractory atonic bladder with persistent urinary retention after surgery seems promising but should be confirmed by further studies. To date, standard treatment of urinary retention after surgery remains self-catheterization. In terms of prevention, surgical nerve sparing techniques have been developed in order to minimize intraoperative injury of pelvic nerve plexus and reduce postoperative morbidity. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Neurogenic Lower Urinary Tract Dysfunction in Adults with Cerebral Palsy: Outcomes following a Conservative Management Approach.

PubMed

Goldfarb, Robert A; Pisansky, Andrew; Fleck, Joseph; Hoversten, Patrick; Cotter, Katherine J; Katorski, Jenna; Liberman, Daniel; Elliott, Sean P

2016-04-01

Cerebral palsy is characterized by motor impairment following injury to the developing brain. Neurogenic lower urinary tract dysfunction is estimated to affect at least a third of children with cerebral palsy. However there are limited data as patients transition to adulthood. We sought to describe the symptoms, sequelae and management of neurogenic lower urinary tract dysfunction in adults with cerebral palsy. We retrospectively reviewed the charts of adult patients with cerebral palsy between 2011 and 2014. Patients with prior bladder reconstruction or catheterization based bladder drainage were excluded from study. Cerebral palsy severity was determined using GMFCS (Gross Motor Function Classification System). A conservative evaluation and treatment paradigm was used. Noninvasive treatments were encouraged. Specifically clean intermittent catheterization, which is often not feasible, is avoided unless urinary retention, hydronephrosis or refractory lower urinary tract symptoms develop. There were 121 patients included in final analysis. Median age was 25 and 61 patients (50%) had GMFCS level V. Noninvasive management failed in 28 of 121 patients (23%) as defined by hydronephrosis in 9, persistent urinary retention in 10 and refractory lower urinary tract symptoms/incontinence in 9. Urethral clean intermittent catheterization was poorly tolerated. Of all patients 25% showed evidence of urolithiasis during the study period. Surgical intervention was rare and associated with significant morbidity. Adults with cerebral palsy may present with variable signs and symptoms of neurogenic lower urinary tract dysfunction. Conservative treatment was successful in more than 75% of patients. Clean intermittent catheterization was poorly tolerated in patients in whom conservative treatment failed. Surgical intervention was rarely indicated and it should be reserved for select individuals. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Undetected penetrating bladder injuries presenting as a spontaneously expulsed bullet during voiding: a rare entity and review of the literature.

PubMed

Kuy, SreyRam; Somberg, Lewis B; Paul, Jasmeet; Brown, Nathaniel; Saving, Allegra; Codner, Panna A

2013-09-01

Patients presenting with a penetrating missile lodged in the pelvis are at risk for having a urinary tract injury. Once in the bladder, the missile can become impacted in the urethra, causing retention that requires extraction. Rarely, the missile can be expulsed spontaneously through the urethra. To describe the world literature regarding undetected penetrating bladder injuries presenting as spontaneously voided bullets and to contribute an additional case to the literature. We present a case report of a 37-year-old man who sustained a gunshot wound to the right buttock, with an undetected urinary system injury and subsequent spontaneous voiding of a bullet. There have been <10 cases reported in the literature of spontaneously expulsed bullets from the urethra, all of which were undetected injuries on initial presentation. Physicians should be aware of the potential for undetected urinary tract injuries in patients with penetrating missiles to the pelvis and understand the appropriate evaluation and management strategies for these injuries. Copyright © 2013 Elsevier Inc. All rights reserved.

Laparoscopic transabdominal preperitoneal repair of inguinal hernia under spinal anesthesia: a pilot study.

PubMed

Zacharoulis, Dimitris; Fafoulakis, Frank; Baloyiannis, Ioannis; Sioka, Eleni; Georgopoulou, Stavroula; Pratsas, Costas; Hantzi, Eleni; Tzovaras, George

2009-09-01

The laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with the well-known advantages of a minimally invasive approach. However, general anesthesia is routinely required for the procedure. Based on our previous experience in regional anesthesia for laparoscopic procedures, we designed a pilot study to assess the feasibility and safety of performing laparoscopic TAPP repair under spinal anesthesia. Forty-five American Society of Anesthesiologists I or II patients with a total of 50 inguinal hernias underwent TAPP repair under spinal anesthesia, using a low-pressure CO(2) pneumoperitoneum. Five patients had bilateral hernias, and 4 patients had recurrent hernias. Thirty hernias were indirect and the remaining direct. Intraoperative incidents, postoperative pain complications, and recovery in general as well as patient satisfaction at the follow-up examination were prospectively recorded. There was 1 conversion from spinal to general anesthesia and 2 conversions from laparoscopic to the open procedure at a median operative time of 50 minutes (range 30-130). Ten patients complained of shoulder pain during the procedure, and 6 patients suffered hypotension intraoperatively. The median pain score (visual analog scale) was 1 (0-5) at 4 hours after the completion of the procedure, 1.5 (0-6) at 8 hours, and 1.5 (0-5) at 24 hours, and the median hospital stay was 1 day (range 1-2). Sixteen patients had urinary retention requiring instant catheterization. At a median follow-up of 20 months (range 10 months-28 months), no recurrence was detected. TAPP repair is feasible and safe under spinal anesthesia. However, it seems to be associated with a high incidence of urinary retention. Further studies are required to validate this technique.

MRI target delineation may reduce long-term toxicity after prostate radiotherapy.

PubMed

Sander, Lotte; Langkilde, Niels Christian; Holmberg, Mats; Carl, Jesper

2014-06-01

Aiming for minimal toxicity after radical prostate cancer (PC) radiotherapy (RT), magnetic resonance imaging (MRI) target delineation could be a possible benefit knowing that clinical target volumes (CTV) are up to 30% smaller, when CTV delineation on MRI is compared to standard computed tomography (CT). This study compares long-term toxicity using CT or MRI delineation before PC RT. Urinary and rectal toxicity assessments 36 months after image-guided RT (78 Gy) using CTC-AE scores in two groups of PC patients. Peak symptom score values were registered. One group of patients (n=72) had standard CT target delineation and gold markers as fiducials. Another group of patients (n=73) had MRI target delineation and a nickel-titanium stent as fiducial. At 36 months no difference in overall survival (92% in both groups, p=0.29) or in PSA-relapse free survival was found between the groups (MRI=89% and CT=94%, p=0.67). A significantly smaller CTV was found in the MRI group (p=0.02). Urinary retention and frequency were significantly reduced in the MRI group (p=0.03 in the matter of both). The overall urinary and rectal toxicity did not differ between the two groups. MRI delineation leads to a significantly reduced CTV. Significantly lower urinary frequency and urinary retention toxicity scores were observed following MRI delineation. The study did not find significant differences in overall urinary or rectal toxicity between the two groups. PSA-relapse survival did not differ between the two groups at 36 months.

Urethral toxicity after LDR brachytherapy: experience in Japan.

PubMed

Tanaka, Nobumichi; Asakawa, Isao; Hasegawa, Masatoshi; Fujimoto, Kiyohide

2015-01-01

Urinary toxicity is common after low-dose-rate (LDR) brachytherapy, and the resolution of urinary toxicity is a concern. In particular, urinary frequency is the most common adverse event among the urinary toxicities. We have previously reported that approximately 70% of patients experience urinary frequency during the first 6 months after seed implantation. Most urinary adverse events were classified as Grade 1, and Grade 2 or higher adverse events were rare. The incidence of urinary retention was approximately 2-4%. A high International Prostate Symptom Score before seed implantation was an independent predictor of acute urinary toxicity of Grade 2 or higher. Several previous reports from the United States also supported this trend. In Japan, LDR brachytherapy was legally approved in 2003. A nationwide prospective cohort study entitled Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation was initiated in July 2005. It is an important issue to limit urinary toxicities in patients who undergo LDR brachytherapy. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Urinary tract infections in older women: a clinical review.

PubMed

Mody, Lona; Juthani-Mehta, Manisha

2014-02-26

Asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) in older women are commonly encountered in outpatient practice. To review management of asymptomatic bacteriuria and symptomatic UTI and review prevention of recurrent UTIs in older community-dwelling women. A search of Ovid (Medline, PsycINFO, Embase) for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013. The clinical spectrum of UTIs ranges from asymptomatic bacteriuria, to symptomatic and recurrent UTIs, to sepsis associated with UTI requiring hospitalization. Recent evidence helps differentiate asymptomatic bacteriuria from symptomatic UTI. Asymptomatic bacteriuria is transient in older women, often resolves without any treatment, and is not associated with morbidity or mortality. The diagnosis of symptomatic UTI is made when a patient has both clinical features and laboratory evidence of a urinary infection. Absent other causes, patients presenting with any 2 of the following meet the clinical diagnostic criteria for symptomatic UTI: fever, worsened urinary urgency or frequency, acute dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness. A positive urine culture (≥105 CFU/mL) with no more than 2 uropathogens and pyuria confirms the diagnosis of UTI. Risk factors for recurrent symptomatic UTI include diabetes, functional disability, recent sexual intercourse, prior history of urogynecologic surgery, urinary retention, and urinary incontinence. Testing for UTI is easily performed in the clinic using dipstick tests. When there is a low pretest probability of UTI, a negative dipstick result for leukocyte esterase and nitrites excludes infection. Antibiotics are selected by identifying the uropathogen, knowing local resistance rates, and considering adverse effect profiles. Chronic suppressive antibiotics for 6 to 12 months and vaginal estrogen therapy effectively reduce symptomatic UTI episodes and should be considered in patients with recurrent UTIs. Establishing a diagnosis of symptomatic UTI in older women requires careful clinical evaluation with possible laboratory assessment using urinalysis and urine culture. Asymptomatic bacteriuria should be differentiated from symptomatic UTI. Asymptomatic bacteriuria in older women should not be treated.

[Urinary catheters prevalence study in a university hospital].

PubMed

Carrouget, J; Legeay, C; Poirier, A; Azzouzi, A-R; Zahar, J-R; Bigot, P

2017-04-01

Urinary tract infection is the most common healthcare-association infection, especially because of urinary catheter. We evaluated our practices concerning catheter insertion and management in our institution. We conducted a single-centre descriptive cross-sectional study during 1 week in September 2014 in all adult departments. We noted prevalence, indications, length, management of urinary catheter (UC) and symptomatic catheter-associated urinary tract infections (SCAUTI). Amongst 1046 patients audited, 125 (12%) had UC. The mean age was 72 years (64.8-79.2). UC prevalence was higher in surgical (88%) and medical (87%) intensive care, urology (50%), geriatrics (18%) and long-term care (18%) departments. The average catheterisation length was 7.8 days (3.8-11.8); it was shorter in surgery than in medicine departments (3.6 vs 9.7 days, P<0.001). Catheters were present for more than 4 days in 60% of the cases. Acute urinary retention was the most frequent indication (59%), significantly more in medical than surgical departments (75% vs 26%). Others indications were perioperative (17%), diuresis monitoring (12%), strict immobilization (4%) and unnecessary indications or staff comfort (4%). A SCAUTI was present in 10% of cases, mostly in medicine department (30% vs 8%). The prevalence of our institution is higher than the national prevalence (8.1%), but still below the European average (17.2%). Control of the risk of CAUTI requires compliance with UC appropriate indications, UC management, and prompt removal of unnecessary UC. 4. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

OnabotulinumtoxinA in urinary incontinence: Prospective Study of a Case Series.

PubMed

Martín-Martínez, A; Fernández-Mederos, A; García-Hernández, J Á

2017-09-01

To assess the safety and efficacy of a single intravesical injection of onabotulinumtoxinA (OnaBTA) for treating urge urinary incontinence (UUI) in women. We performed a prospective case-series study of consecutive patients with refractory UUI treated with an intravesical injection of OnaBTA. The patients were administered 100 units of OnaBTA injected into the bladder wall following 4 weeks of flushing with anticholinergic agents or beta 3 agonists. The urodynamic and clinical endpoints were evaluated before and 6 months after the injection of OnaBTA. The primary study endpoint was the number of episodes of urinary leakage. A total of 204 of the 210 selected patients conducted a valid visit 6 months after the therapeutic application. At 6 months of treatment with OnaBTA, 110 (53.9%) patients remained continent and were considered a success. However, 57 (27.9%) patients experienced one episode of urinary leakage per day, and 37 (18.2%) had 2 or more. In terms of the urodynamic parameters, we observed the following changes: increase in maximum bladder capacity (P<.0001) and reduced maximum pressure of the detrusor (P<.0001). In terms of the safety profile, 8 (3.9%) patients had self-limiting haematuria during the procedure, which resolved spontaneously, and 9 (4.4%) patients had acute urinary retention that required intermittent catheterisation. This study supports the use of OnabotulinumtoxinA in patients with urge urinary incontinence that does not respond to medical treatment. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Autologous Pubovaginal Sling for the Treatment of Concomitant Female Urethral Diverticula and Stress Urinary Incontinence.

PubMed

Enemchukwu, Ekene; Lai, Caroline; Reynolds, William Stuart; Kaufman, Melissa; Dmochowski, Roger

2015-06-01

To describe our experience with concomitant repair of urethral diverticula and stress urinary incontinence (SUI) with autologous pubovaginal sling (PVS). A retrospective chart review between January 2006 and 2013 identified 38 women undergoing concomitant diverticulectomy and rectus sheath PVS. Patient demographics, presenting symptoms, prior urethral surgery, concomitant procedures, postoperative outcomes, and complications were evaluated. The mean duration of symptoms was 56.7 months. Eleven patients presented with recurrent diverticula and 5 patients had prior SUI surgery (3 midurethral slings, 1 PVS, and 1 bulking agent). One patient had a prior urethrolysis. All other slings were cut or excised at the time of surgery. All women had demonstrable SUI on cough stress test or urodynamics. The mean follow-up was 12.7 months. All postoperative voiding cystourethrograms were negative for contrast extravasation. One patient required prolonged (>4 weeks) suprapubic tube drainage for urinary retention. Four others required an additional 1 week of suprapubic tube drainage. Eighteen patients (47%) reported mixed urinary symptoms. Of these, 9 had complete resolution, whereas 9 experienced significant improvement. Overall, 97.3% reported resolution of their dysuria, dyspareunia, and pain symptoms and 90% reported complete resolution of their SUI symptoms. There were 2 urethral diverticula recurrences and 2 SUI recurrences. Perioperative complications, including hemorrhage, sling erosion, or urethrovaginal fistulas, were not observed. Concomitant PVS placement is a safe and effective treatment option for SUI in patients undergoing urethral diverticulectomy. The risks and benefits should be weighed and management individualized. Copyright © 2015 Elsevier Inc. All rights reserved.

Combined prostatic urethral lift and remodeling of the prostate and bladder neck: a modified transurethral approach in the treatment of symptomatic lower urinary tract obstruction.

PubMed

Schoenthaler, Martin; Sievert, Karl-Dietrich; Schoeb, Dominik Stefan; Miernik, Arkadiusz; Kunit, Thomas; Hein, Simon; Herrmann, Thomas R W; Wilhelm, Konrad

2018-02-15

The aim of the study was to evaluate the feasibility and safety of combining prostatic urethral lift (PUL) and a limited resection of the prostatic middle lobe or bladder neck incision in the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Twenty-eight patients were treated at two tertiary centers and followed prospectively. Patient evaluations included patient characteristics, relief of LUTS symptoms, erectile and ejaculatory function, continence, operative time and adverse events. Patients were followed for a mean of 10.9 months. Patient characteristics were as follows: age 66 years (46-85), prostate volume 39.6 cc (22-66), preoperative IPSS/AUASI 20 (6-35)/QoL 3.9 (1-6)/peak flow 10.5 mL/s (4.0-19)/post-void residual volume (PVR) 123 mL (0-500). Mean operating time was 31 min (9-55). Postoperative complications were minor except for the surgical retreatment of one patient for blood clot retention (Clavien 3b). One patient required catheterization due to urinary retention. Reduction of symptoms (IPSS - 59.6%), increase in QoL (+ 49.0%), increase in flow (+ 111.5%), and reduction of PVR (- 66.8%) were significant. Antegrade ejaculation was always maintained. Our data suggest that a combination of PUL and transurethral surgical techniques is feasible, safe, and effective. This approach may be offered to patients with moderate size prostates including those with unfavorable anatomic conditions for PUL. This procedure is still 'minimally invasive' and preserves sexual function. In addition, it may add to a higher functional efficacy compared to PUL alone. DRKS00008970.

Intermediate-term efficacy of Tm:YAG laser prostate vaporesection for bladder outlet obstruction: initial experience from a UK teaching hospital.

PubMed

Pal, Raj P; Khan, Masood A

2012-01-01

To assess the safety and clinical efficacy of Tm:YAG laser vaporesection of the prostate (ThuVaRP) at intermediate-term follow-up. We identified the first 60 consecutive patients who underwent ThuVaRP at our institute. Operative outcomes assessed were resection time, resection weight, drop in haemoglobin, transfusion rate, catheter time and complication rate. The International Prostate Symptom Score (IPSS) was documented at a mean follow-up period of 19 months postoperatively. 45/60 patients underwent treatment due to lower urinary tract symptoms secondary to benign prostatic obstruction, 11/60 patients had a long-term catheter in situ for refractory urinary retention secondary to benign prostatic obstruction, and 4/60 patients had bladder outflow obstruction secondary to adenocarcinoma of the prostate. 1/60 patients developed urosepsis, 1/60 patients developed a urinary tract infection and 1/60 patients required 3-way catheterization and irrigation due to haematuria. No patients required a blood transfusion. The mean IPSS at a mean follow-up interval of 19 months (range 15-28 months) was 5.1 (range 1-23). Postoperative maximum flow rate improved from 7.9 to 17.1 ml/s, and post-micturition residual volume decreased from 254 to 86 ml. ThuVaRP is safe and appears to have durable efficacy at intermediate follow-up. Copyright © 2011 S. Karger AG, Basel.

Parameter uncertainty analysis of a biokinetic model of caesium

DOE PAGES

Li, W. B.; Klein, W.; Blanchardon, Eric; ...

2014-04-17

Parameter uncertainties for the biokinetic model of caesium (Cs) developed by Leggett et al. were inventoried and evaluated. The methods of parameter uncertainty analysis were used to assess the uncertainties of model predictions with the assumptions of model parameter uncertainties and distributions. Furthermore, the importance of individual model parameters was assessed by means of sensitivity analysis. The calculated uncertainties of model predictions were compared with human data of Cs measured in blood and in the whole body. It was found that propagating the derived uncertainties in model parameter values reproduced the range of bioassay data observed in human subjects atmore » different times after intake. The maximum ranges, expressed as uncertainty factors (UFs) (defined as a square root of ratio between 97.5th and 2.5th percentiles) of blood clearance, whole-body retention and urinary excretion of Cs predicted at earlier time after intake were, respectively: 1.5, 1.0 and 2.5 at the first day; 1.8, 1.1 and 2.4 at Day 10 and 1.8, 2.0 and 1.8 at Day 100; for the late times (1000 d) after intake, the UFs were increased to 43, 24 and 31, respectively. The model parameters of transfer rates between kidneys and blood, muscle and blood and the rate of transfer from kidneys to urinary bladder content are most influential to the blood clearance and to the whole-body retention of Cs. For the urinary excretion, the parameters of transfer rates from urinary bladder content to urine and from kidneys to urinary bladder content impact mostly. The implication and effect on the estimated equivalent and effective doses of the larger uncertainty of 43 in whole-body retention in the later time, say, after Day 500 will be explored in a successive work in the framework of EURADOS.« less

[Herpes zoster infection with acute urinary retention].

PubMed

Jakab, G; Komoly, S; Juhász, E

1990-03-11

The history of a young female patient is presented. She developed urine retention of sudden onset as a complication of herpes zoster infection manifested in the sacral dermatomes. Symptomatic and antiviral treatments were introduced with full recovery of bladder function. The correct diagnosis of this rare and benign complication of herpes zoster infection can help to avoid unnecessary and invasive examinations.

Sacral nerve stimulation for neuromodulation of the lower urinary tract.

PubMed

Hubsher, Chad P; Jansen, Robert; Riggs, Dale R; Jackson, Barbara J; Zaslau, Stanley

2012-10-01

Sacral neuromodulation (SNM) has become a standard treatment option for patients suffering from urinary urge incontinence, urgency-frequency, and/or nonobstructive urinary retention refractory to conservative and pharmacologic treatment. Since its initial development, the manufacturer of InterStim therapy (Medtronic, Inc., Minneapolis, MN, USA), has introduced technical modifications, while surgeons and researchers have adapted and published various innovations and alterations of the implantation technique. In this article, we feature our SNM technique including patient selection, comprehensive dialogue/evaluation, procedure details, and appropriate follow up. Although there is often great variability in patients with lower urinary tract dysfunction, we maintain that great success can be achieved with a systematic and methodical approach to SNM.

Repetitive Prostatic Massage and Drug Therapy as an Alternative to Transurethral Resection of the Prostate

PubMed Central

Hennenfent, Bradley R.; Lazarte, Alfred R.; Feliciano, Antonio E.

2006-01-01

We describe 5 men with urinary retention and indwelling urethral catheters who were treated with repetitive prostatic massage, antimicrobials, alpha blockers, and – in 2 cases – finasteride. We retrospectively reviewed the charts of all patients presenting to the genitourinary clinic with indwelling urinary catheters during a 1-year period. Five men (mean age, 70 years; range, 64–76; SD 4.47) presented to the Manila Genitourinary Clinic (Cebu Branch), Cebu, Philippines, wearing indwelling urinary catheters placed for acute urinary retention. Urologists had told all 5 men that they needed to undergo transurethral resection of the prostate (TURP). The Cebu genitourinary physician removed the catheters, instituted repetitive prostatic massage, and diagnosed all 5 patients with prostatitis. All 5 patients received repetitive prostatic massage, alpha-blocker medication, and antibiotic therapy, whereas finasteride was given to 2 patients. During treatment, statistically significant improvements occurred in global symptom severity scores, urethral white blood cell (WBC) counts, WBC counts of the expressed prostatic secretions (EPS), EPS red blood cell (RBC) counts, urinary WBC counts, and urinary RBC counts. Fluorescing Chlamydia elementary bodies disappeared in 3 of the 4 positive patients by the end of treatment. (One patient was not available for retesting.) Repetitive prostatic massage, antimicrobial therapy, alpha-blocker therapy, and – in 2 cases – finasteride enabled catheter removal in all 5 men (100%) as well as successful urination in all 5 men (100%). TURP has been prevented for a mean of 2.53 years (range, 16–38 months). PMID:17415302

Loss of urinary voiding sensation due to herpes zoster.

PubMed

Hiraga, Akiyuki; Nagumo, Kiyomi; Sakakibara, Ryuji; Kojima, Shigeyuki; Fujinawa, Naoto; Hashimoto, Tasuku

2003-01-01

A case of sacral herpes zoster infection in a 56-year-old man with the complication of loss of urinary voiding sensation is presented. He had typical herpes zoster eruption on the left S2 dermatome, hypalgesia of the S1-S4 dermatomes, and absence of urinary voiding sensation. There was no other urinary symptom at the first medical examination. Urinary complications associated with herpes zoster are uncommon, but two types, acute cystitis and acute retention, have been recognized. No cases of loss of urinary voiding sensation due to herpes zoster have been reported. In this case, hypalgesia of the sacral dermatomes was mild compared to the marked loss of urethral sensation. This inconsistency is explained by the hypothesis that the number of urethral fibers is very small as compared to that of cutaneous fibers, therefore, urethral sensation would be more severely disturbed than cutaneous sensation. Copyright 2003 Wiley-Liss, Inc.

Comparison of two aquaretic drugs (niravoline and OPC-31260) in cirrhotic rats with ascites and water retention.

PubMed

Bosch-Marcé, M; Poo, J L; Jiménez, W; Bordas, N; Leivas, A; Morales-Ruiz, M; Muñoz, R M; Pérez, M; Arroyo, V; Rivera, F; Rodés, J

1999-04-01

kappa-Opioid receptor agonists (niravoline) or nonpeptide antidiuretic hormone (ADH) V2 receptor antagonists (OPC-31260) possess aquaretic activity in cirrhosis; however, there is no information concerning the effects induced by the chronic administration of these drugs under this condition. To compare the renal and hormonal effects induced by the long-term oral administration of niravoline, OPC-31260, or vehicle, urine volume, urinary osmolality, sodium excretion, and urinary excretion of aldosterone (ALD) and ADH were measured in basal conditions and for 10 days after the daily oral administration of niravoline, OPC-31260, or vehicle to cirrhotic rats with ascites and water retention. Creatinine clearance, serum osmolality, ADH mRNA expression, and systemic hemodynamics were also measured at the end of the study. Niravoline increased water excretion, peripheral resistance, serum osmolality, and sodium excretion and reduced creatinine clearance, ALD and ADH excretion, and mRNA expression of ADH. OPC-31260 also increased water metabolism and sodium excretion and reduced urinary ALD, although the aquaretic effect was only evident during the first 2 days, and no effects on serum osmolality, renal filtration, and systemic hemodynamics were observed. Therefore, both agents have aquaretic efficacy, but the beneficial therapeutic effects of the long-term oral administration of niravoline are more consistent than those of OPC-31260 in cirrhotic rats with ascites and water retention.

Racial differences in potassium homeostasis in response to differences in dietary sodium in girls123

PubMed Central

Wigertz, Karin; Martin, Berdine R; Braun, Michelle; Pratt, J Howard; Peacock, Munro; Weaver, Connie M

2010-01-01

Background: Racial differences in the renal disposition of potassium may be related to mechanisms for the greater susceptibility to hypertension in blacks than in whites. Objective: Our objective was to study the racial differences in the renin-angiotensin-aldosterone system and in potassium balance in black and white girls consuming a controlled diet that was low in potassium with 2 amounts of sodium intake (low compared with high). Design: The studies reported here were performed in 40 black and 28 white girls, aged 11–15 y, under highly controlled metabolic conditions. The studies comprised 2 sessions of 20-d metabolic balance sessions, at 2 amounts of dietary sodium intake (58 and 170 mmol · L−1 · d−1), in a crossover design and with a constant dietary potassium intake of 50 mmol · L−1 · d−1. Repeated-measures analysis of variance was used to test for racial differences in potassium output and retention by sodium intakes. Results: Thirty black and 20 white girls completed the study. Urinary potassium excretion was lower in blacks than in whites, regardless of sodium intake (P < 0.05), with no differences in fecal or sweat potassium excretion. Cumulative potassium retention was significantly higher in blacks while consuming the low sodium diet. Plasma aldosterone concentrations after upright posture were significantly lower in blacks than in whites but were similar when supine, as were urinary aldosterone excretion rates. On week 3, blood pressure, body weight, urinary volume, creatinine, and serum sodium and potassium were similar. Conclusion: The well-known racial difference in urinary potassium excretion appears to be at least in part due to greater renal retention of potassium in black girls. PMID:20007307

Patient-related risk factors for urinary retention following ambulatory general surgery: a systematic review and meta-analysis.

PubMed

Mason, Sam E; Scott, Alasdair J; Mayer, Erik; Purkayastha, Sanjay

2016-06-01

Postoperative urinary retention (POUR) is a source of avoidable patient harm. The aim of this review is to identify and quantify the role of patient-related risk factors in the development of POUR following ambulatory general surgery. Studies published until December 2014 were identified by searching MEDLINE, EMBASE, and PsycINFO databases. Risk factors assessed in 3 or more studies were meta-analyzed. Twenty-one studies were suitable for inclusion consisting of 7,802 patients. The incidence of POUR was 14%. Increased age and the presence of lower urinary tract symptoms significantly increased risk with odds ratios [ORs] of 2.11 (95% confidence interval [CI] 1.15 to 3.86) and 2.83 (1.57 to 5.08), respectively. Male sex was not associated with developing POUR (OR .96, 95% CI .62 to 1.50). Preoperative α-blocker use significantly decreased the incidence of POUR with an OR of .37 (95% CI .15 to .91). Increased age and the presence of lower urinary tract symptoms increase the risk of POUR, while α-blocker use confers protection. Male sex was not associated with POUR. These findings assist in preoperative identification of patients at high risk of POUR. Copyright © 2015 Elsevier Inc. All rights reserved.

Relationship of bladder dysfunction with upper urinary tract deterioration in cerebral palsy.

PubMed

Gündoğdu, Gökhan; Kömür, Mustafa; Avlan, Dinçer; Sarı, Ferda Bacaksızlar; Delibaş, Ali; Taşdelen, Bahar; Naycı, Ali; Okuyaz, Cetin

2013-10-01

Although lower urinary tract dysfunction (LUTD) in patients with cerebral palsy (CP) has been previously documented by clinical observations and urodynamic tests, its correlation with upper urinary tract deterioration (UUTD) has not been demonstrated. This paper documents symptoms and urodynamic findings of LUTD and their relationship with UUTD in 33 children with CP. By sonography, 4 of these children were found to have UUTD. Age was found to correlate with UUTD, but gender difference and mental or motor functions did not. When comparing urinary symptoms with UUTD, incontinence (n = 31) did not correlate, but on the other hand symptoms of detrusor sphincter dyssynergia (interrupted voiding, urinary retention, hesitancy; n = 5) and culture proven febrile urinary tract infections (n = 4) did. Abnormal urodynamics findings were not diagnostic. We conclude that, apart from incontinence, dysfunctional voiding symptoms and febrile urinary tract infections are valuable indicators of UUTD. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

High-power (80-w) KTP laser vaporization of the prostate in the management of urinary retention: long-term follow up

NASA Astrophysics Data System (ADS)

Kleeman, M.; Nseyo, Unyime O.

2004-07-01

Introduction and Objectives: We have previously reported the use of high-powered photoselective vaporization of the prostate (PVP) for patients in urinary retention due to benign prostatic hyperplasia (BPH). PVP is a relatively new treatment for bladder outlet obstruction due to BPH, using laser energy to vaporize obstructing prostatic tissue. This study investigates the long-term follow up of patients treated with PVP for urinary retention. Materials and Methods: All participants signed informed consent, and were treated with high power 80 W quasi-continuous wave potassium-titanyl-phosphate (KTP) laser. Ten patients underwent the procedure from December 2001 until the present. One patient was excluded from the study for failure to return for follow-up. Mean patient follow-up was nine months, maximum of twelve months. Results: The mean pre-operative gland size by trans-rectal ultrasound was 48 grams. Mean urethral length was 3.2 cm. Mean laser time was 48.2 minutes and the mean energy usage was 82.2 kJoules. There were no peri-operative complications such as sepsis or measurable postoperative bleeding. The preoperative AUA Symptom Score (AUASS) decreased from a mean of 22.6 preoperatively to 17 at nine months postoperatively (p = 0.032). The Quality of Life Score (QOL) decreased from 4.6 preoperatively to 3.25 at 12 months postoperatively (p = 0.26). The maximum urine flow rate increased from a mean of 7.7 cc/sec preoperatively to 14.5 cc/sec at six months follow-up (p = 0.03). Conclusions: This follow-up study suggests that HP-KTP has a durable response in patients treated specifically for retention. It significantly improved urine flow rate and symptom score, and had a trend towards improvement in subjective quality of life. HP-KTP prostatectomy should be considered in treating patients in retention, especially those with significant co-morbidities or taking anticoagulation.

Urinary Retention

MedlinePlus

... Electromyography . Electromyography uses special sensors to measure the electrical activity of the muscles and nerves in and ... Grants & Grant History Research Resources Research at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information Diabetes Digestive ...

Suspicious urinary cytology with negative evaluation for malignancy in the diagnostic investigation of haematuria: how to follow up?

PubMed Central

Nabi, G; Greene, D; Donnel, M O

2004-01-01

Aims: To define the natural history of patients with suspicious urinary cytology and negative initial evaluation for malignancy in the investigation of haematuria. Patients and methods: Data from the hospital information support system on urinary cytology examinations carried out at one centre were audited over a period of 24 months. There were 102 patients who had suspicious urinary cytology for malignant cells with negative initial evaluation. Follow up investigations, treatment, and final outcome were noted. Results: There were 102 patients with suspicious urinary cytology and negative initial evaluation for malignancy in 24 months, with a mean follow up of 15.7 months. Seventy patients had no obvious pathology on initial investigations. Forty one patients were found to have urological malignancies (29 bladder, eight ureteric, and four prostate) on follow up. All patients diagnosed as having urothelial malignancies on follow up had either persistent suspicious cytology (29) or recurrent haematuria (eight). The mean duration for appearance of lesions was 5.6 months (range, 3–12 months). Three patients had suspicious digital rectal examination and biopsies confirmed adenocarcinoma of the prostate. One patient had urinary retention and transurethral resection of prostate showed prostatic adenocarcinoma. The presence of suspicious cells on repeat urine analysis was the only significant factor in predicting the presence of urothelial tumours (p  =  0.002). Conclusion: Patients with persistent suspicious/positive cytology or recurrent haematuria need further evaluation and follow up. Asymptomatic patients or patients with obvious benign pathology do not require repeat evaluation. Careful urological evaluation, including prostate, should be carried out in these patients. PMID:15047737

Long-term Risk of Urinary Adverse Events in Curatively Treated Patients With Rectal Cancer: A Population-Based Analysis.

PubMed

Kwaan, Mary R; Fan, Yunhua; Jarosek, Stephanie; Elliott, Sean P

2017-07-01

Treatment modalities for rectal cancer, including radiation, are associated with urinary adverse effects. The purpose of this study was to determine the influence of surgery and radiation therapy for rectal cancer on long-term urinary complications. Using the Surveillance Epidemiology and End Results-Medicare data set from the United States, patients with rectal cancer older than 66 years of age who underwent rectal resection between 1992 and 2007 were stratified into treatment groups that accounted for surgical resection and the timing of radiation therapy, if used. A control group of patients who did not have rectal cancer were matched by age, sex, demographics, and comorbidities. The primary outcome was a urinary adverse event defined as a relevant urinary diagnosis with an associated procedure. Patients with rectal cancer in different treatment groups were compared with control patients using a propensity-adjusted, multivariable Cox regression analysis. The study was conducted with the Surveillance Epidemiology and End Results-Medicare data set from the United States at our institution. Of the 11,068 patients with rectal cancer, 56.2% had surgical resection alone, 21.7% received preoperative radiation, and 22.1% received postoperative radiation. The median follow-up for all of the groups of patients was >2 years. All of the groups of patients with rectal cancer were more likely to develop a urinary adverse event compared with control subjects. Adjusted HRs were 2.28 (95% CI, 2.02-2.57) for abdominoperineal resection alone, 2.24 (95% CI, 1.79-2.80) for preoperative radiation and surgical resection, 2.04 (95% CI, 1.70-2.44) for surgical resection and postoperative radiation, and 1.69 (95% CI, 1.52-1.89) for low anterior resection alone. Treatment patterns are somewhat outdated, with a large proportion of patients receiving postoperative radiation. The data did not allow for accurate assessment of urinary tract infections or mild urinary retention that is not managed with a procedure. Rectal cancer surgery with or without radiation is associated with a higher risk of urinary complications requiring procedures. Patients who undergo low anterior resection without radiation tend toward the lowest risk for a urinary adverse event.

The rate and pattern of urea infusion into the rumen of wethers alters nitrogen balance and plasma ammonia.

PubMed

Recavarren, M I; Milano, G D

2014-12-01

Changes in N balance, urinary excretion of purine derivative (PD), urea, creatinine and ammonia and plasma ammonia, glucose, urea, insulin and IGF-1 were examined in four wethers (37 ± 2.6 kg BW). The animals were fitted with permanent ruminal catheters, fed lucerne hay (9.4 MJ/day; 23 g N/day; 7 g soluble N/day, 6 equal meals/day) and treated with contrasting rates of urea infusion into the rumen: first, a continuous infusion (CT), at 3.2 mg urea-N/min for 10 days and then a discontinuous infusion (DT) at 156 mg urea-N/min for 4 min; in 6 daily doses with the meals for 7 days. N balance was calculated from pooled samples of faeces and urine. Jugular blood samples were collected before and 1.5 h after the morning meal (M1) on days CT10, DT2, DT4 and DT6. N retention decreased during DT (p = 0.01) due to a significant increase of N excretion in urine (4 g/day; p = 0.009) and faeces (1 g/day; p = 0.02). Dry matter (p < 0.001) and N digestibility in vivo (p = 0.01) decreased significantly during DT. Urinary urea and PD excretion were not altered by treatment. Significant linear (p = 0.004) and quadratic (p = 0.001) effects were observed for plasma ammonia in M1 (from 170 CT10 to 235 μm DT2 and returned to 120 μm DT6). No changes were observed in plasma glucose, urea, insulin and IGF-1. Results indicate that changes from CT to DT reduced N retention in sheep due to enhanced urinary N excretion, but it was not associated with changes in urinary urea or PD excretion; or plasma concentrations of insulin and IGF-1. As the dry matter (DM) an N digestibility could account a 0.23 of the decrease in N retention; the largest fraction of the reduction in N retention remained unexplained by the results. Journal of Animal Physiology and Animal Nutrition © 2014 Blackwell Verlag GmbH.

Postoperative analgesic efficacy of single-shot and continuous transversus abdominis plane block after laparoscopic cholecystectomy: A randomized controlled clinical trial.

PubMed

Choi, Yun-Mi; Byeon, Gyeong-Jo; Park, Soon-Ji; Ok, Young-Min; Shin, Sang-Wook; Yang, Kwangho

2017-06-01

To compare the analgesic efficacy of ultrasound-guided single-shot and continuous transversus abdominis plane (TAP) block to that of IV-PCA in patients undergoing laparoscopic cholecystectomy. Prospective randomized controlled trial. Post-anesthesia care unit and General ward. 108 American Society of Anesthesiologist (ASA) physical status I-II patients undergoing laparoscopic cholecystectomy. Group A received IV-PCA; group B received both ultrasound-guided single-shot TAP block with 0.2% ropivacaine (20mL) and IV-PCA; and group C received continuous TAP block using an ultrasound-guidance-inserted indwelling catheter. In group C, infusion of 0.2% ropivacaine at a basal rate of 3mL/h, bolus dose of 4mL, and a lockout interval of 30min was maintained for 48h postoperatively. The primary outcome was evaluated analgesic efficacy using the numeric rating scale (NRS) for 48h postoperatively. Other outcomes included the number of patients requiring additional analgesics, patient satisfaction with postoperative pain control, and incidence of postoperative adverse events. Compared to other groups, group C had higher deep abdominal NRS at 1h postoperatively (P<0.05), and lower incidence of postoperative urinary retention (P<0.05). There were no significant intergroup differences in the number of patients requiring additional analgesics, and patient satisfaction with postoperative pain control. Compared to IV-PCA with or without single-shot TAP block, ultrasound-guided continuous TAP block provided similar analgesia in somatic pain and less analgesia in visceral pain. Moreover, the latter resulted in a lower incidence of postoperative urinary retention. Copyright © 2017 Elsevier Inc. All rights reserved.

[Evaluation and clinical management of urination disorders in 1,025 patients in a geriatric department].

PubMed

Abrahamik, A; Leblond, J B; Perilliat, I; Henry, O; Loison, M; De Madet, M; Cotteret, R

1993-01-01

Evaluation of voluntary urination and measurement of the post-voiding residue enabled the identification of 6 groups among 1,025 patients 83 +/- 7 years old: 400 normal patients (N); 97 with retention but without incontinence (R); 133 incontinent without retention (I); 50 incontinent with retention (IR); 236 who failed to urinate voluntarily (MO); 109 with indwelling catheters (SAD). Incontinence and indwelling catheters were more common in women; men more frequently failed to urinate voluntarily (p < 0.01). The IR and SAD groups had more urinary infections (p < 0.01) and included more invalids (p < 0.001). The MO and SAD groups had more demented members (p < 0.001) and a higher death rate (p < 0.001). Management consisted of a 48-hour diary of urinations (R and IR groups), scheduled micturitions (I and MO groups) and treatment of urinary infections. Evaluation of bladder sphincter function (n = 291) showed that bladder hypoesthesia was prevalent in groups R and IR and that bladder hyperactivity was predominant in groups I, MO and SAD. Among the 314 patients discharged from the hospital, 181 were reevaluated: good results were obtained for 43% of the initially incontinent and for 53% of those with retention. The indwelling catheters were removed from 82% of the SAD group.

Evaluation of Implementation of a National Point-of-Care Ultrasound Training Program

ClinicalTrials.gov

2018-05-09

Other Acute Illnesses Presenting to the Hospital; Heart Failure; Pneumonia; Deep Venous Thrombosis; Cellulitis; Abdominal Aortic Aneurysm; Acute Cholecystitis; Peritoneal Free Fluid; Hydronephrosis; Pleural Effusion; Urinary Retention

Urinary Tract Infections in Older Women

PubMed Central

Mody, Lona; Juthani-Mehta, Manisha

2014-01-01

IMPORTANCE Asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) in older women are commonly encountered in outpatient practice. OBJECTIVE To review management of asymptomatic bacteriuria and symptomatic UTI and review prevention of recurrent UTIs in older community-dwelling women. EVIDENCE REVIEW A search of Ovid (Medline, PsycINFO, Embase) for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013. RESULTS The clinical spectrum of UTIs ranges from asymptomatic bacteriuria, to symptomatic and recurrent UTIs, to sepsis associated with UTI requiring hospitalization. Recent evidence helps differentiate asymptomatic bacteriuria from symptomatic UTI. Asymptomatic bacteriuria is transient in older women, often resolves without any treatment, and is not associated with morbidity or mortality. The diagnosis of symptomatic UTI is made when a patient has both clinical features and laboratory evidence of a urinary infection. Absent other causes, patients presenting with any 2 of the following meet the clinical diagnostic criteria for symptomatic UTI: fever, worsened urinary urgency or frequency, acute dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness. A positive urine culture (≥105 CFU/mL) with no more than 2 uropathogens and pyuria confirms the diagnosis of UTI. Risk factors for recurrent symptomatic UTI include diabetes, functional disability, recent sexual intercourse, prior history of urogynecologic surgery, urinary retention, and urinary incontinence. Testing for UTI is easily performed in the clinic using dipstick tests. When there is a low pretest probability of UTI, a negative dipstick result for leukocyte esterase and nitrites excludes infection. Antibiotics are selected by identifying the uropathogen, knowing local resistance rates, and considering adverse effect profiles. Chronic suppressive antibiotics for 6 to 12 months and vaginal estrogen therapy effectively reduce symptomatic UTI episodes and should be considered in patients with recurrent UTIs. CONCLUSIONS AND RELEVANCE Establishing a diagnosis of symptomatic UTI in older women requires careful clinical evaluation with possible laboratory assessment using urinalysis and urine culture. Asymptomatic bacteriuria should be differentiated from symptomatic UTI. Asymptomatic bacteriuria in older women should not be treated. PMID:24570248

A simple technique to facilitate treatment of urethral strictures with optical internal urethrotomy.

PubMed

Stamatiou, Konstantinos; Papadatou, Aggeliki; Moschouris, Hippocrates; Kornezos, Ioannis; Pavlis, Anargiros; Christopoulos, Georgios

2014-01-01

Urethral stricture is a common condition that can lead to serious complications such as urinary infections and renal insufficiency secondary to urinary retention. Treatment options include catheterization, urethroplasty, endoscopic internal urethrotomy, and dilation. Optical internal urethrotomy offers faster recovery, minimal scarring, and less risk of infection, although recurrence is possible. However, technical difficulties associated with poor visualization of the stenosis or of the urethral lumen may increase procedural time and substantially increase the failure rates of internal urethrotomy. In this report we describe a technique for urethral catheterization via a suprapubic, percutaneous approach through the urinary bladder in order to facilitate endoscopic internal urethrotomy.

Complications employing the holmium:YAG laser.

PubMed

Beaghler, M; Poon, M; Ruckle, H; Stewart, S; Weil, D

1998-12-01

We report the operative and early postoperative complications and limitations in 133 patients treated with the holmium laser. Complications included urinary tract infection (N = 3), postoperative bradycardia (1), inverted T-waves (1), intractable flank pain (1), urinary retention (1), inability to access a lower-pole calix with a 365-microm fiber (9), stone migration (5), and termination of procedure because of poor visibility (2). No ureteral perforations or strictures occurred, and no complications were directly attributable to the laser. The holmium laser was capable of fragmenting all urinary calculi in this study. In our initial experience, the holmium laser is safe and effective in the treatment of urinary pathology. Use of laser fibers larger than 200 microm occasionally limits deflection of the endoscope into a lower-pole or dependent calix.

[Nerve sparing techniques in deep endometriosis surgery to prevent urinary or digestive functional disorders: Techniques and results: CNGOF-HAS Endometriosis Guidelines].

PubMed

Rabischong, B; Botchorishvili, R; Bourdel, N; Curinier, S; Campagne-Loiseau, S; Pouly, J L; Canis, M

2018-03-01

To evaluate the feasibility and functional urinary and digestive results of nerve sparing techniques in endometriosis surgery. A research on the medline/pubmed database using specific keywords (nerve sparing, endometriosis, pelvic nerves) identified 7 publications among about 50 whose purpose was to describe the feasibility, the techniques and the functional results of nerve preservation in this indication. Among them there are: 2 uncontrolled retrospective studies, 3 prospective non-randomized studies, a meta-analysis and a review of the literature. Nerve preservation requires a perfect knowledge of the anatomy of the pelvic autonomic system. The laparoscopic approach is preferred by the different authors due to its anatomical advantage. The feasibility of this technique seems to be demonstrated despite certain limitations in the different studies and depending of the retroperitoneal extension of the lesions. When feasible, it is likely to significantly improve postoperative urinary function (urinary retention) compared to a conventional technique. It is observed no difference regarding digestive function. Nerve sparing in this indication is a technique the feasibility of which has been demonstrated and is subject to the topography and extent of the disease. In the absence of invasion or entrapment of pelvic autonomic nerves by endometriosis, this technique improves postoperative voiding function (NP3). During pelvic surgery for endometriosis, it is recommended to identify and preserve autonomic pelvic nerves whenever possible (GradeC). Copyright © 2018. Published by Elsevier Masson SAS.

[Urological emergencies at the Dakar university teaching hospital: epidemiological, clinical and therapeutic features].

PubMed

Fall, B; Diao, B; Fall, P A; Diallo, Y; Sow, Y; Ondongo, A A M; Diagana, M; Ndoye, A K; Ba, M; Diagne, B A

2008-11-01

To present the epidemiological, clinical and therapeutic features of the urological emergencies in Senegal, West Africa. The authors conducted a 20 months retrospective study that analyzed the epidemiological, clinical and therapeutic features of all urological emergencies admitted to the urology department of the university teaching hospital Aristide-Le-Dantec (Dakar). There were 1237 urological emergencies. The mean age of the patients was 58.8 years (range one month-94 years). The sex ratio (M/F) was 20.32. These patients had an age equal to or higher than 60 years in 50.7% of the cases. The most frequent illness was urinary retention (53%) and genitor-urinary system infectious, which represented as a whole 16.4% of the cases. The gangrenes of male external genitalia (Fournier's gangrene) accounted for 4.1% of the cases and the priapism 1.3%. In emergency, 331 surgical operations were performed. The most performed procedures were the installation of a suprapubic catheter (59.8%) and debridement of a gangrene of male external genitalia (15.4%). The most frequent urological emergency in our country was the acute urinary retention. Some serious illness like gangrene of male external genitalia (Fournier's gangrene) and priapism are not rare there.

Management of Urethral Strictures After Hypospadias Repair.

PubMed

Snodgrass, Warren T; Bush, Nicol C

2017-02-01

Strictures of the neourethra after hypospadias surgery are more common after skin flap repairs than urethral plate or neo-plate tubularizations. The diagnosis of stricture after hypospadias repair is suspected based on symptoms of stranguria, urinary retention, and/or urinary tract infection. It is confirmed by urethroscopy during anticipated repair, without preoperative urethrography. The most common repairs for neourethra stricture after hypospadias surgery are single-stage dorsal inlay graft and 2-stage labial mucosa replacement urethroplasty. Copyright © 2016 Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lipshultz, L.I.; Corriere, J.N. Jr.

Technetium-99m radioactive colloid particles were suspended in an iodine- 131 Hippuran radioactive fluid medium and placed into the bladders of six patients. Two normal patients and one with only one urinary tract infection voided the fluid and particles synchronously, while three with recurrent urinary tract infections eliminated the particles at a much slower rate than the fluid. A change in either the physical contour or secretory activity of the bladder urothelium is postulated as the cause of particle retention in these patients with chronic infections. (auth)

Pilot study of Alteplase (tissue plasminogen activator) for treatment of urinary clot retention in an in vitro model.

PubMed

Ritch, Chad R; Ordonez, Maria A; Okhunov, Zhamshid; Araujo, Juan; Walsh, Rhonda; Baudin, Vania; Lee, Daniel; Badani, Ketan K; Gupta, Mantu; Landman, Jaime

2009-08-01

The management of urinary clot retention and hematuria involves manual irrigation with sterile water or normal saline via a Foley catheter followed by continuous bladder irrigation. Irrigation may become difficult because of the formation of dense blood clots. Tissue plasminogen activator (t-PA/Alteplase) may be a useful pharmacological agent to improve the efficacy of manual irrigation of large, dense clots. The goal of the current study was to compare t-PA to sterile water for clot irrigation in an in vitro model. In vitro models of clot retention were created using 500-cc urinary leg bags each filled with 80 cc of unpreserved whole blood from a healthy volunteer. Each model was incubated at 25 degrees C for 24 hours to allow clot formation. Four models each with 25 mL solution of t-PA at concentrations of 2, 1, 0.5, and 0.25 mg/mL were evaluated and compared to a control (25 mL sterile water). Models were instilled with solution (t-PA or control) and incubated for 30 minutes at 37 degrees C, and then irrigated with sterile water via 18F Foley by a blinded investigator. Three separate experiments were conducted, and statistical analysis was performed comparing various irrigation parameters. Clot evacuation with 25 mL of t-PA at a concentration of 2 mg/mL (50 mg) was significantly easier (p = 0.05) and faster (p < 0.05) than the sterile water control. The mean time for clot evacuation in this model was 2.7 minutes for t-PA solution 2 mg/mL versus 7.3 minutes for the control (p < 0.05). Compared to the control, irrigation with t-PA solution 2 mg/mL also required less irrigant (180 mL vs. 500 mL) (p < 0.05) for complete evacuation. There was a similar trend in efficacy for the lower doses of t-PA, but this was not statistically significant. In this in vitro study, a single 25 mL instillation of t-PA solution 2 mg/mL is significantly better than sterile water alone for clot evacuation. In vivo animal studies are pending.

Urinary Proteolytic Activation of Renal Epithelial Na+ Channels in Chronic Heart Failure.

PubMed

Zheng, Hong; Liu, Xuefei; Sharma, Neeru M; Li, Yulong; Pliquett, Rainer U; Patel, Kaushik P

2016-01-01

One of the key mechanisms involved in renal Na(+) retention in chronic heart failure (CHF) is activation of epithelial Na(+) channels (ENaC) in collecting tubules. Proteolytic cleavage has an important role in activating ENaC. We hypothesized that enhanced levels of proteases in renal tubular fluid activate ENaC, resulting in renal Na(+) retention in rats with CHF. CHF was produced by left coronary artery ligation in rats. By immunoblotting, we found that several urinary serine proteases were significantly increased in CHF rats compared with sham rats (fold increases: furin 6.7, prostasin 23.6, plasminogen 2.06, and plasmin 3.57 versus sham). Similar increases were observed in urinary samples from patients with CHF. Whole-cell patch clamp was conducted in cultured renal collecting duct M-1 cells to record Na(+) currents. Protease-rich urine (from rats and patients with CHF) significantly increased the Na(+) inward current in M-1 cells. Two weeks of protease inhibitor treatment significantly abrogated the enhanced diuretic and natriuretic responses to ENaC inhibitor benzamil in rats with CHF. Increased podocyte lesions were observed in the kidneys of rats with CHF by transmission electron microscopy. Consistent with these results, podocyte damage markers desmin and podocin expressions were also increased in rats with CHF (increased ≈2-folds). These findings suggest that podocyte damage may lead to increased proteases in the tubular fluid, which in turn contributes to the enhanced renal ENaC activity, providing a novel mechanistic insight for Na(+) retention commonly observed in CHF. © 2015 American Heart Association, Inc.

Urinary proteolytic activation of renal epithelial Na+ channels in chronic heart failure

PubMed Central

Zheng, Hong; Liu, Xuefei; Sharma, Neeru M.; Li, Yulong; Pliquett, Rainer U; Patel, Kaushik P.

2015-01-01

One of the key mechanisms involved in renal Na+ retention in chronic heart failure (CHF) is activation of epithelial Na+ channels (ENaC) in collecting tubules. Proteolytic cleavage has an important role in activating ENaC. We hypothesized that enhanced levels of proteases in renal tubular fluid activate ENaC resulting in renal Na+ retention in rats with CHF. CHF was produced by left coronary artery ligation in rats. By immunoblotting, we found that several urinary serine proteases were significantly increased in CHF rats compared to sham rats (fold increases: furin 6.7, prostasin 23.6, plasminogen 2.06 and plasmin 3.57 vs. sham). Similar increases were observed in urinary samples from patients with CHF. Whole-cell patch-clamp was conducted in cultured renal collecting duct M-1 cells to record Na+ currents. Protease-rich urine (from rats and patients with CHF) significantly increased the Na+ inward current in M-1 cells. Two weeks of protease inhibitor treatment significantly abrogated the enhanced diuretic and natriuretic responses to ENaC inhibitor benzamil in rats with CHF. Increased podocyte lesions were observed in the kidneys of rats with CHF by transmission electron microscopy. Consistent with these results, podocyte damage markers desmin and podocin expressions were also increased in rats with CHF (increased ~2 folds). These findings suggest that podocyte damage may lead to increased proteases in the tubular fluid which in turn contributes to the enhanced renal ENaC activity, providing a novel mechanistic insight for Na+ retention commonly observed in CHF. PMID:26628676

Effect of glycine on recovery of bladder smooth muscle contractility after acute urinary retention in rats.

PubMed

Hong, Sung K; Son, Hwancheol; Kim, Soo W; Oh, Seung-June; Choi, Hwang

2005-12-01

To investigate the effects of glycine on the recovery of bladder smooth muscle contractility after acute urinary retention. Bladder overdistension was induced in Sprague-Dawley rats by an infusion of saline (twice the threshold volume), maintained for 2 h. From 15 min before emptying of the bladder until 2 h after, saline or glycine solution was infused i.v. At 30 min, 2 h and 1 week after bladder emptying, samples of bladder tissue were taken for muscle strip study, malondialdehyde (MDA) assay, ATP assay, Western blotting for apoptosis-related molecules (Bcl-2, Bax, Caspase-3), and histological analysis including terminal deoxynucleotidyl transferase-mediated nick-end labelling staining. The results were compared among normal control, saline-treated and glycine-treated rats. In the glycine-treated group, muscle strip contractile responses induced by electrical-field stimulation and carbachol were both significantly greater at 1 week after bladder emptying than in the saline-treated group. The results of the ATP assay appeared to correspond with those of the muscle strip study. The saline-treated group had significantly higher MDA levels at 30 min after bladder emptying than the glycine-treated group. At 2 h after bladder emptying, there was significantly more apoptosis and greater leukocyte infiltration in the saline-treated group than in the glycine-treated group. While pro-apoptotic Bax and caspase-3 were down-regulated, Bcl-2 was up-regulated in the glycine-treated group. Glycine infusions might improve the contractile responses of bladder smooth muscle after acute urinary retention by reducing oxidative damage and apoptosis.

Magnesium retention from metabolic-balance studies in female adolescents: impact of race, dietary salt, and calcium123

PubMed Central

Palacios, Cristina; Wigertz, Karin; Braun, Michelle; Martin, Berdine R; McCabe, George P; McCabe, Linda; Pratt, J Howard; Peacock, Munro; Weaver, Connie M

2013-01-01

Background: Previously, we showed that black girls retained more calcium than white girls did and that salt loading negatively affected calcium retention. Racial differences likely exist in other bone minerals also, such as magnesium, in response to salt loading during growth. Objective: We studied racial differences in magnesium metabolism in response to dietary sodium and calcium during rapid bone growth. Design: Twenty-seven white and 40 black girls (11–15 y old) were studied for 3 wk while they consumed low-sodium (1.3 g/d) and high-sodium (3.8 g/d) diets by using a randomized-order, crossover metabolic study with 3 dietary calcium intakes; the magnesium dietary intake was fixed at 230 mg/d. Urine and feces were collected during each 3-wk period in 24-h pools and analyzed for magnesium. A mixed-model ANOVA was used to determine the effect of race and dietary sodium with calcium intake as a covariate. Results: Salt loading or calcium intake had no significant effect on urinary magnesium excretion. Blacks excreted significantly less urinary magnesium (mean ± SD: 83.8 ± 25.6 mg/d) than did whites (94.9 ± 27.3 mg/d; P < 0.05). No effects were observed in fecal magnesium excretion. Magnesium retention was higher with the low-sodium diet (50.1 ± 44.0 mg/d) than with the high-sodium diet (39.3 ± 49.8 mg/d) (P < 0.05), with no effects of race or calcium intake. Salt loading had no effect on biomarkers. Whites had higher 25-hydroxyvitamin D and insulin-like growth factor binding protein 3 but lower 1,25-dihydroxyvitamin D and parathyroid hormone concentrations. Conclusions: Blacks excreted less urinary magnesium than did whites. Magnesium retention was similar between races but higher with the low-sodium diet. Kinetic studies are needed to fully explain magnesium homeostasis. This trial was registered at clinicaltrials.gov as NCT01564238. PMID:23553157

Bile acid malabsorption after continent urinary diversion with an ileal reservoir.

PubMed

Olofsson, G; Fjälling, M; Kilander, A; Ung, K A; Jonsson, O

1998-09-01

We determine the effect of urinary diversion with a Kock ileal reservoir on bile acid absorption and bowel habits. We asked 96 patients with a Kock ileal urinary reservoir to record bowel habits and abdominal symptoms for 1 week. Data on 75 patients were further analyzed. Bile acid absorption was determined in 29 healthy control subjects, in 17 before and 6 months after continent urinary diversion, and in 21, 2 to 14 years postoperatively. Bile acid absorption was considered pathological when retention of less than 10% of an oral capsule containing selenium-75 labeled tauroselcholic acid (SeHCAT) was noted after 1 week. Mean number of defecations plus or minus standard deviation was 9.4 +/- 6.1 (75 cases). Of the patients 13% had 15 or more stools per week and 15% complained of always having loose stools. Mean value for the SeHCAT test was 32 +/- 19% preoperatively and 17 +/- 16% 6 months postoperatively (p = 0.0023). The corresponding value for healthy controls was 39 +/- 18%. Significant relationships were found between the results of the SeHCAT test postoperatively, and the number of stools per week and consistency of the feces. All patients with more than 10 defecations per week had a pathological SeHCAT test. Most patients with an ileal urinary reservoir have fairly normal bowel habits. Bile acid absorption is significantly reduced postoperatively and approximately a third of the patients have a pathological SeHCAT test. Preoperative investigation of bowel habits is recommended and a SeHCAT test should be performed in patients with frequent, loose defecations. Other types of diversion should be offered when preoperative retention is below 10 to 20% especially in patients with impaired anal control.

Managing lower urinary tract symptoms in men.

PubMed

MacKenzie, Kenneth R; Aning, Jonathan J

2016-04-01

Male lower urinary tract symptoms (LUTS) are common and increase in prevalence with age. Up to 90% of men aged 50 to 80 may suffer from troublesome LUTS. Men may attend expressing direct concern about micturition, describing one or more LUTS and the related impact on their quality of life. Frequently men may present for other medical or urological reasons such as concern regarding their risk of having prostate cancer or erectile dysfunction but on taking a history bothersome LUTS are identified. Men may present late in the community with urinary retention: the inability to pass urine. A thorough urological history is essential to inform management. It is important to determine whether men have storage or voiding LUTS or both. All patients must have a systematic comprehensive examination including genitalia and a digital rectal examination. Investigations performed in primary care should be guided by the history and examination findings, taking into account the impact of the LUTS on the individual's quality of life. Current NICE guidelines recommend the following to be performed at initial assessment: frequency volume chart (FVC); urine dipstick to detect blood, glucose, protein, leucocytes and nitrites; and prostate specific antigen. Men should be referred for urological review if they have: bothersome LUTS which have not responded to conservative management or medical therapy; LUTS in association with recurrent or persistent UTIs; urinary retention; renal impairment suspected to be secondary to lower urinary tract dysfunction; or suspected urological malignancy. All patients not meeting criteria for immediate referral to urology can be managed initially in primary care. Based on history, examination and investigation findings an individualised management plan should be formulated. Basic lifestyle advice should be given regarding reduction or avoidance of caffeinated products and alcohol. The FVC should guide advice regarding fluid intake management and all medications should be reviewed.

The role of bladder diverticula in the prevalence of acute urinary retention in patients with BPH who are candidates to surgery.

PubMed

Iscaife, Alexandre; Dos Anjos, Gabriel; Barbosa, Cristovão; Nahas, Willian Carlos; Srougi, Miguel; Antunes, Alberto Azoubel

2018-03-15

The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It's role in acute urinary retention (AUR) is not totally understood. To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery. We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis. There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD >5.0 cm vs. ≤5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012). The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR. Copyright® by the International Brazilian Journal of Urology.

[Effect of electroacupuncture of different acupoints on the excitability of detrusor muscle and the expression of BDNF and TrkB in the spinal cord of rats with urinary retention due to spinal cord injury].

PubMed

Wang, Jun-hua; Chen, Bang-guo; Yin, Jing; Wang, Gang; Zou, Wei-Geng; Luo, Xiao-juan

2009-12-01

To observe the effect of electroacupuncture (EA) of different acupoints on the expression of brain-derived neurotrophic factor (BDNF) and tropomyosine receptor kinase B (TrkB) in the spinal cord and the excitability of detrusor muscle of the uninary bladder in rats with urinary retention owing to spinal cord injury (SCI). A total of 100 female SD rats were randomly divided into normal, sham-operation (sham), model, EA-Guanyuan (CV 4), and EA-Shuidao (ST 28) groups, with 20 cases in each. SCI induced urinary retention model was established by using weight dropping method. EA (1 mA, 2 Hz/15 Hz) was applied to "Guanyuan" (CV 4) and "Shuidao" (ST 28) respectively for 20 min, once a day for 10 days. The excitability (tone, contraction frequency) of the detrusor muscle of the bladder was detected in vitro by using electrophysiological method, and the expression of BDNF and TrkB in spinal cord was determined by immunohistochemistry staining. In comparison with normal control and sham groups, the tension and the contraction frequency of detrusor muscle in model group lowered significantly (P<0.05), while compared with model group, both the tension and contraction frequency of detrusor muscle increased pronouncedly in EA-CV 4 and EA-ST 28 groups (P<0.05), and the effect of EA-CV 4 was apparently superior to that of EA-ST 28 (P<0.05). In comparison with normal and sham groups, the BDNF and TrkB immunoreaction positive cells in the spinal cord were significantly more in model group (P<0.05). Compared with model group, those of EA-CV 4 and EA-ST 28 groups were obviously further increased (P<0.05), and the effect of EA-CV 4 group was markedly superior to that of EA-ST 28 group (P<0.05). EA of CV 4 and ST 28 can raise the excitability of the smooth muscle of the uninary bladder in rats with SCI-induced urinary retention, which may be related to its effects in upregulating the expression of BDNF and TrkB in the spinal cord. The effects of EA of CV 4 were evidently superior to those of EA of ST 28.

Long-term safety and efficacy of single-tablet combinations of solifenacin and tamsulosin oral controlled absorption system in men with storage and voiding lower urinary tract symptoms: results from the NEPTUNE Study and NEPTUNE II open-label extension.

PubMed

Drake, Marcus J; Chapple, Christopher; Sokol, Roman; Oelke, Matthias; Traudtner, Klaudia; Klaver, Monique; Drogendijk, Ted; Van Kerrebroeck, Philip

2015-02-01

Short-term trials have demonstrated the efficacy and safety of combination therapy using antimuscarinics and α-blockers in men with lower urinary tract symptoms (LUTS). The Study of Solifenacin Succinate and Tamsulosin Hydrochloride OCAS (oral controlled absorption system) in Males with Lower Urinary Tract Symptoms (NEPTUNE) II is the first long-term study using solifenacin (Soli) and the oral controlled absorption system formulation of tamsulosin (TOCAS). To evaluate long-term (up to 52 wk) safety and efficacy of flexible dosing of two fixed-dose combinations (FDC) of Soli plus TOCAS in men with moderate to severe storage symptoms and voiding symptoms. Patients with both storage and voiding LUTS, maximum urinary flow rate of 4.0-12.0 ml/s, prostate size <75 ml, and postvoid residuals ≤ 150 ml, who completed the 12-wk, double-blind NEPTUNE study could continue in the 40-wk, open-label NEPTUNE II study. FDC of Soli 6 mg plus TOCAS 0.4 mg, or Soli 9 mg plus TOCAS 0.4mg; patients could switch between doses in NEPTUNE II. Safety and efficacy data from NEPTUNE and NEPTUNE II were combined to cover a 52-wk period. Primary efficacy end points were total International Prostate Symptom Score (IPSS) and total urgency and frequency score (TUFS); secondary end points included IPSS storage and voiding subscores, micturition diary variables, and quality of life parameters. In all, 1066 men completed NEPTUNE and received one dose or more of study medication in NEPTUNE II. Treatment-emergent adverse events were reported in 499 (46.8%) patients who participated in NEPTUNE II; most were mild or moderate. Urinary retention occurred in 13 of 1208 (1.1%) patients receiving one or more FDCs in NEPTUNE and/or NEPTUNE II; 8 (0.7%) required catheterisation (acute urinary retention [AUR]). Reductions in total IPSS and TUFS during NEPTUNE were maintained for up to 52 wk of FDC treatment, with mean reductions of 9.0 (standard deviation [SD]: 5.7) and 10.1 (SD: 9.2), respectively, from baseline to end of treatment. Clinically relevant improvements were also observed for secondary efficacy end points. Long-term treatment with FDC Soli plus TOCAS was well tolerated and efficacious in men with storage and voiding LUTS, with a low incidence of AUR. Treatment with solifenacin plus tamsulosin in a fixed-dose combination tablet was well tolerated by men with lower urinary tract symptoms. Improvements in symptoms were achieved after 4 wk of treatment, with further improvements at week 16 maintained for up to 52 wk throughout the study. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Medical and Surgical Treatment Modalities for Lower Urinary Tract Symptoms in the Male Patient Secondary to Benign Prostatic Hyperplasia: A Review

PubMed Central

Macey, Matthew Ryan; Raynor, Mathew C.

2016-01-01

Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) is one of the most common ailments affecting aging men. Symptoms typically associated with BPH include weak stream, hesitancy, urgency, frequency, and nocturia. More serious complications of BPH include urinary retention, gross hematuria, bladder calculi, recurrent urinary tract infection, obstructive uropathy, and renal failure. Evaluation of BPH includes a detailed history, objective assessment of urinary symptoms with validated questionnaires, and measurement of bladder function parameters, including uroflowmetry and postvoid residual. In general, treatment of LUTS associated with BPH is based on the effect of the symptoms on quality of life (QOL) and include medical therapy aimed at reducing outlet obstruction or decreasing the size of the prostate. If medical therapy fails or is contraindicated, various surgical options exist. As the elderly population continues to grow, the management of BPH will become more common and important in maintaining patient's QOL. PMID:27582609

Botulinum toxin A for the Treatment of Overactive Bladder.

PubMed

Hsieh, Po-Fan; Chiu, Hung-Chieh; Chen, Kuan-Chieh; Chang, Chao-Hsiang; Chou, Eric Chieh-Lung

2016-02-29

The standard treatment for overactive bladder starts with patient education and behavior therapies, followed by antimuscarinic agents. For patients with urgency urinary incontinence refractory to antimuscarinic therapy, currently both American Urological Association (AUA) and European Association of Urology (EAU) guidelines suggested that intravesical injection of botulinum toxin A should be offered. The mechanism of botulinum toxin A includes inhibition of vesicular release of neurotransmitters and the axonal expression of capsaicin and purinergic receptors in the suburothelium, as well as attenuation of central sensitization. Multiple randomized, placebo-controlled trials demonstrated that botulinum toxin A to be an effective treatment for patients with refractory idiopathic or neurogenic detrusor overactivity. The urinary incontinence episodes, maximum cystometric capacity, and maximum detrusor pressure were improved greater by botulinum toxin A compared to placebo. The adverse effects of botulinum toxin A, such as urinary retention and urinary tract infection, were primarily localized to the lower urinary tract. Therefore, botulinum toxin A offers an effective treatment option for patients with refractory overactive bladder.

Benign prostatic hyperplasia (BPH) management in the primary care setting.

PubMed

Kapoor, Anil

2012-10-01

Benign prostate hyperplasia (BPH) occurs in up to 50% of men by age 50, and the incidence increases with age. This common clinical problem is diagnosed by history, including the International Prostate Symptom Score (IPSS) questionnaire, and physical examination by digital rectal examination (DRE). Initial management for BPH includes lifestyle modification, and smooth muscle relaxant alpha blocker therapy. Alpha blockers usually take effect quickly within 3-5 days, and have minimal side effects. Current commonly used alpha blockers include the selective alpha blockers tamsulosin (Flomax), alfusosin (Xatral), and silodosin (Rapaflo). For patients with larger prostates, the 5-alpha reductase inhibitor class (finasteride (Proscar) and dutasteride (Avodart)) work effectively to shrink prostate stroma resulting in improved voiding. The 5-ARI class of drugs, in addition to reducing prostate size, also reduce the need for future BPH-related surgery, and reduce the risk of future urinary retention. Drugs from the phosphodiesterase-5 (PDE-5) inhibitor class may now be considered for treating BPH. Once daily 5 mg tadalafil has been shown to improve BPH-related symptoms and is currently approved to treat patients with BPH. Referral to a urologist can be considered for patients with a rising prostate-specific antigen (PSA), especially while on 5-ARI, failure of urinary symptom control despite maximal medical therapy, suspicion of prostate cancer, hematuria, recurrent urinary infections, urinary retention, or renal failure. Currently the primary care physician is armed with multiple treatment options to effectively treat men with symptomatic BPH.

Pathogenesis of dysplastic kidney associated with urinary tract obstruction in utero.

PubMed

Nagata, Michio; Shibata, Sawako; Shu, Yujin

2002-01-01

Renal dysplasia is the major cause of chronic renal failure in children, and is commonly associated with urinary tract obstruction. There are two phenotypes of renal dysplasia associated with urinary tract abnormality, multicystic dysplastic kidney (MCDK) and obstructive dysplasia (ORD). Previous observations by Potter and co-workers suggested that cystic dilatation of the ureteric bud ampula was the cause of renal dysplasia. In this context, our recent investigation of human fetal dysplastic kidneys provided an alternative explanation for the evolution of renal dysplasia. We suggested that in utero urinary tract obstruction may cause urine retention in functioning nephrons and lead to glomerular cysts in the nephrogenic zone. The mechanism was common to MCDK and ORD, albeit at different sites of obstruction. Expansion of glomerular cysts with tubular dilatation (cysts) disturbs the subsequent nephron induction and may contribute to the abnormal development of fetal kidneys.

Sacral Herpes Zoster Associated with Voiding Dysfunction in a Young Patient with Scrub Typhus.

PubMed

Hur, Jian

2015-06-01

When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature. In the described case, scrub typhus probably induced sufficient stress to reactivate the varicella zoster virus. Early recognition of this problem is imperative for prompt and appropriate management, as misdiagnosis can lead to long-term urinary dysfunction. It is important that a diagnosis of herpes zoster be considered, especially in patients with sudden onset urinary retention.

Sacral Herpes Zoster Associated with Voiding Dysfunction in a Young Patient with Scrub Typhus

PubMed Central

2015-01-01

When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature. In the described case, scrub typhus probably induced sufficient stress to reactivate the varicella zoster virus. Early recognition of this problem is imperative for prompt and appropriate management, as misdiagnosis can lead to long-term urinary dysfunction. It is important that a diagnosis of herpes zoster be considered, especially in patients with sudden onset urinary retention. PMID:26157595

Update on voiding dysfunction managed with suprapubic catheterization

PubMed Central

2017-01-01

As the population ages the prevalence of long-term urinary catheters, especially in the elderly, is going to increase. Urinary catheters are usually placed to manage urinary retention or incontinence that cannot be managed any other way. There is significant morbidity associated with an indwelling catheter. The commonest problems are catheter blockages, infection and bladder stones. These will occur with a similar incidence with either a suprapubic or a urethral catheter. Urethral complications such as strictures, scrotal infection and erosion are less common with suprapubic catheterization (SPC). However the benefit of having a SPC needs to be balanced against the risks involved in inserting the catheter suprapubically. Patient reported symptoms show that a SPC is more comfortable and better tolerated than a urethral catheter. However there needs to be more research into developing better catheters that reduce the frequency of urinary infections and blockages and hence catheter morbidity. PMID:28791237

A case of hyperammonemia with obstructive urinary tract infection by urease-producing bacteria.

PubMed

Goda, Toshiaki; Watanabe, Kotaro; Kobayashi, Junya; Nagai, Yasuharu; Ohara, Nobuyuki; Takahashi, Daisuke

2017-03-28

A 79-year-old woman was admitted emergently for disturbance of consciousness. Her consciousness level was Japan coma scale 20, and she presented with hypermyotonia. Brain magnetic resonance imaging and cerebrospinal fluid examination showed normal findings. Her blood tests showed an increased ammonia level of 291 μg/dl with normal liver function. We catheterized the bladder for urinary retention. Eight hours after admission, the blood level of ammonia decreased to 57 μg/dl and the patient's consciousness level improved. Corynebacterium pseudodiphtheriticum, which is a bacteria producing urease, was detected from a urine culture. It is important to recognize that obstructive urinary tract infection caused by urease-producing bacteria can cause hyperammonemia.

Metabolic alkalosis during immobilization in monkeys (M. nemestrina)

NASA Technical Reports Server (NTRS)

Young, D. R.; Yeh, I.; Swenson, R. S.

1983-01-01

The systemic and renal acid-base response of monkeys during ten weeks of immobilization was studied. By three weeks of immobilization, arterial pH and bicarbonate concentrations were elevated (chronic metabolic alkalosis). Net urinary acid excretion increased in immobilized animals. Urinary bicarbonate excretion decreased during the first three weeks of immobilization, and then returned to control levels. Sustained increases in urinary ammonium excretion were seen throughout the time duration of immobilization. Neither potassium depletion nor hypokalemia was observed. Most parameters returned promptly to the normal range during the first week of recovery. Factors tentatively associated with changes in acid-base status of monkeys include contraction of extracellular fluid volume, retention of bicarbonate, increased acid excretion, and possible participation of extrarenal buffers.

A Giant Urethral Calculus.

PubMed

Sigdel, G; Agarwal, A; Keshaw, B W

2014-01-01

Urethral calculi are rare forms of urolithiasis. Majority of the calculi are migratory from urinary bladder or upper urinary tract. Primary urethral calculi usually occur in presence of urethral stricture or diverticulum. In this article we report a case of a giant posterior urethral calculus measuring 7x3x2 cm in a 47 years old male. Patient presented with acute retention of urine which was preceded by burning micturition and dribbling of urine for one week. The calculus was pushed in to the bladder through the cystoscope and was removed by suprapubic cystolithotomy.

State of the art of prostatic arterial embolization for benign prostatic hyperplasia.

PubMed

Petrillo, Mario; Pesapane, Filippo; Fumarola, Enrico Maria; Emili, Ilaria; Acquasanta, Marzia; Patella, Francesca; Angileri, Salvatore Alessio; Rossi, Umberto G; Piacentini, Igor; Granata, Antonio Maria; Ierardi, Anna Maria; Carrafiello, Gianpaolo

2018-04-01

Prostatectomy via open surgery or transurethral resection of the prostate (TURP) is the standard treatment for benign prostatic hyperplasia (BPH). Several patients present contraindication for standard approach, individuals older than 60 years with urinary tract infection, strictures, post-operative pain, incontinence or urinary retention, sexual dysfunction, and blood loss are not good candidates for surgery. Prostatic artery embolization (PAE) is emerging as a viable method for patients unsuitable for surgery. In this article, we report results about technical and clinical success and safety of the procedure to define the current status.

Hem-o-lok clip: a neglected cause of severe bladder neck contracture and consequent urinary incontinence after robot-assisted laparoscopic radical prostatectomy.

PubMed

Cormio, Luigi; Massenio, Paolo; Lucarelli, Giuseppe; Di Fino, Giuseppe; Selvaggio, Oscar; Micali, Salvatore; Carrieri, Giuseppe

2014-02-20

Hem-o-lok clips are widely used during robot-assisted and laparoscopic radical prostatectomy to control the lateral pedicles. There are a few reports of hem-o-lok clip migration into the bladder or vesico-urethral anastomosis and only four cases of hem-o-lok clip migration resulting into bladder neck contracture. Herein, we describe the first case, to our knowledge, of hem-o-lok clip migration leading to severe bladder neck contracture and subsequent stress urinary incontinence. A 62-year-old Caucasian man underwent robot-assisted laparoscopic radical prostatectomy for a T1c Gleason 8 prostate cancer. One month after surgery the patient was fully continent; however, three months later, he presented with acute urinary retention requiring suprapubic drainage. Urethroscopy showed a hem-o-lok clip strongly attached to the area between the vesico-urethral anastomosis and the urethral sphincter and a severe bladder neck contracture behind it. Following cold-knife urethral incision and clip removal, the bladder neck contracture was widely resected. At 3-month follow-up, the patient voided spontaneously with a peak flow rate of 9.5 ml/sec and absence of post-void residual urine, but leaked 240 ml urine at the 24-hour pad test. To date, at 1-year follow-up, his voiding situation remains unchanged. The present report provides further evidence for the risk of hem-o-lok clip migration causing bladder neck contracture, and is the first to demonstrate the potential of such complication to result into stress urinary incontinence.

Effect of different concentrations of dietary P and Ca on plasma inorganic P and urinary P excretion using noncolostomized and colostomized broilers.

PubMed

Manangi, Megharaja K; Maharjan, Pramir; Coon, Craig N

2018-02-01

Two 5-d bioassays were conducted to explore the P physiological threshold in broilers based on plasma inorganic P (iP), urinary P and Ca, and excreta P and Ca measurements in non-colostomized and colostomized broilers fed with different concentrations of non-phytate P (NPP) and Ca. In Experiment 1, 80 40-day-old Cobb 500 non-colostomized male broilers were assorted into 8 groups consisting of 10 broilers each and placed in individual metabolic cages. Similarly, 8 colostomized broilers of same age were allotted to 8 individual metabolic cages. The experimental diets consisted of a corn soybean meal basal containing 0.17% phytate P (PP) with 8 concentrations (0.08, 0.13, 0.18, 0.23, 0.28, 0.33, 0.38, and 0.45%) of NPP. The dietary Ca concentration was maintained at 0.5% by adjusting a 185-micron particle size limestone with each concentration of added P from added calcium phosphate, dibasic, monohydrate. After Experiment 1, broilers were fed a standard grower diet for 5 d and Experiment 2 was conducted the same as Experiment 1; however, Ca was maintained at 0.9% for all test diets. Plasma iP, urinary P and Ca, and total P (TP) and Ca retention along with phytate P hydrolysis were measured. At 0.5% Ca dietary level, the inflection points for dietary NPP obtained from segmented line regression analysis for plasma iP, urinary P, and urinary Ca were 0.26% (±0.04 SE), 0.28% (±0.01 SE), and 0.30% (±0.04 SE), respectively. The similar values for 0.9% Ca diets were 0.27% (±0.03 SE), 0.21% (±0.03 SE), and 0.30% (±0.0 SE), respectively. In summary, the present findings suggest that an increased dietary NPP would increase plasma inorganic P concentration along with increased % retention of TP and NPP until the broilers reach a point of physiological steady state (7.51 mg iP/dL - 8.13 mg iP/dL as found in this study). Excess P beyond physiological threshold is eliminated in urine coupled with decreased % retention. © 2017 Poultry Science Association Inc.

Improving clinical outcomes for women with overactive bladder or urinary retention symptoms: a comparison of motor response voltages (1-9 V) during Stage 1 sacral neuromodulation.

PubMed

Marinkovic, Serge P; Ford, Joseph C

2018-04-10

To assess whether the utilisation of a motor response of <3 V during Stage 1 sacral neuromodulation (SNM) results in better clinical outcomes compared to >4 V in patients with overactive bladder (OAB) or urinary retention symptoms. An observational, retrospective, double cohort review was conducted of 339 female patients who had experienced medically recalcitrant OAB or urinary retention symptoms. Between September 2001 and September 2014, both cohorts underwent successful Stage 1 to Stage 2 SNM placement. Group A, included 174 women with a motor response at ≤3 V; and Group B, evaluated 110 women with a motor response at ≥4 V for medically recalcitrant OAB. Group C, compared 33 women with a motor response at ≤3 V; and Group D, documented 22 women with a motor response at ≥4 V for non-obstructive urinary retention. Patients completed 3-day voiding diaries, the Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and Patient Global Impression of Improvement Questionnaire. The mean (sd) follow-up was 116.3 (30.3) months in Group A and 112 (34.6) months in Group B (P < 0.354); 150.5 (20.4) months in Group C and 145.8 (17.2) months in Group D (P < 0.38). Successful conversion of Stage 1 to Stage 2 showed statistically significant improvement for both <3-V groups (Groups A and C). Group A had a 93.5% (174/186) conversion rate vs 72.3% (110/152) in Group B for OAB symptoms (P < 0.001). Group C had a 94% (34/36) conversion rate vs 70% (21/30) in Group D (P < 0.017). Defined as a ≥50% reduction in frequency, urgency, urgency incontinence and nocturia, and UDI-6 and IIQ-7 scores, the success rate for Group A was 82.1% (143/174) and for Group B was 63% (69/110) (P < 0.001). The mean battery life improved in both <3-V cohorts (P < 0.001). Annual reprogramming sessions were reduced in Group A and Group C (P < 0.001). Subset analysis of variance showed no statistical improvement in most patient outcomes when 1-V subjects were compared to 2- and 3-V cohorts. However, 32% of 1-V patients (P < 0.001) noted the onset of severe pelvic/perirectal pain and big toe plantar flexion movement with small increments in voltage (0.1-0.2 V) during reprogramming. Only 7% of 2-V and 1% of 3-V patients experienced this complication. Significant improvement was noted (up to 40%) in most clinical voiding parameters in the <3-V patients for both OAB and urinary retention. While <3 V will still statistically improve patient outcomes, a voltage <2 V may elicit self-reprogramming pain with severe bellows and plantar flexion movement, which may discourage patients from therapy adjustments. We recommend randomised, controlled trials to confirm these results. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Clinical study on treatment of hyperuricaemia by retention enema of Chinese herbal medicine combined with allopurinol.

PubMed

Chen, Qian; Ma, Li; Akebaier, Wupu

2009-12-01

To study the effect of retention enema of Chinese herbal medicine combined with allopurinol in treating hyperuricaemia (HUE). Seventy-eight patients with HUE were assigned to two: groups, the 40 patients in the treated group were treated with retention enema of Chinese herbal medicine combined with oral intake of allopurinol, and the 38 patients in the control group were treated with allopurinol alone. The therapeutic course for all was 6 weeks. The clinical efficacy, changes of symptoms, blood levels of uric acid and lipids, renal function, and 24 h urinary micro-albumin were observed. The total effective rate was: 92.5% in the treated group, which was significantly higher than that in the control group (68.4%, P<0.05). After treatment, the score of symptoms in the treated group decreased from 9.43+/-1.15 scores to 3.25+/-0.85 scores, significantly lower than that in the control group (9.75+/-1.43 scores vs 9.25+/-0.82 scores, P<0.01). Moreover, the post-treatment improvements in blood uric acid, blood lipids, renal function and 24h urinary micro-albumin in the treated group were all better than those in the control group (P<0.05 or P<0.01). Retention enema with: Chinese herbal medicine combined with allopurinol could obviously reduce the uric acid level in blood, improve patients' renal function and lipid metabolism, and alleviate the clinical symptoms in patients with HUE.

Retention of urine in anogenital herpetic infection.

PubMed

Oates, J K; Greenhouse, P R

1978-04-01

In 17 patients, 15 women and 2 men, acute retention of urine developed in association with an attack of anogenital herpes. Constipation, blunting of sensation over the 2nd and 3rd sacral dermatomes, and neuralgic pains in the same area (with absence of the bulbocavernosus reflex in some individuals) suggested localised lumbosacral meningomyelitis with involvement of mainly sacral-nerve roots. The urinary dysfunction persisted on average for ten days and in 4 patients was severe enough to warrant catheterisation. Anogenital herpes should always be considered as a possible cause of acute retention of urine in sexually active young people and the possibility of occult herpetic infection of the cervix and rectum should be investigated.

Diagnostic yield of lumbosacral magnetic resonance imaging requested by paediatric urology consultations.

PubMed

Fernández-Ibieta, M; Rojas Ticona, J; Villamil, V; Guirao Piñera, M J; López García, A; Zambudio Carmona, G

2017-11-01

In the historical series, the diagnostic yield of lumbosacral magnetic resonance imaging to rule out occult spinal dysraphism (or occult myelodysplasia), requested by paediatric urology, ranged from 2% to 15%. The aim of this study was to define our cost-effectiveness in children with urinary symptoms and to define endpoints that increase the possibility of finding occult spinal dysraphism. A screening was conducted on patients with urinary dysfunction for whom an magnetic resonance imaging was requested by the paediatric urology clinic, for persistent symptoms after treatment, voiding dysfunction or other clinical or urodynamic findings. We analysed clinical (UTI, daytime leaks, enuresis, voiding dysfunction, urgency, renal ultrasonography, lumbosacral radiography, history of acute urine retention, skin stigma and myalgia) and urodynamic endpoints (hyperactivity or areflexia, voiding dysfunction, interrupted pattern, accommodation value and maximum flow). A univariate analysis was conducted with SPSS 20.0. We analysed 21 patients during the period 2011-2015. The median age was 6 years (3-10). Three patients (14.3%) had occult spinal dysraphism: one spinal lipoma, one filum lipomatosus and one caudal regression syndrome with channel stenosis. The endpoints with statistically significant differences were the myalgias and the history of acute urine retention (66.7% vs. 5.6%, P=.04; OR= 34; 95%CI: 1.5-781 for both endpoints). The diagnostic yield of magnetic resonance imaging requested for children with urinary dysfunctions without skin stigma or neuro-orthopaedic abnormalities is low, although nonnegligible. In this group, the patients with a history of acute urine retention and muscle pain (pain, «cramps») can experience a greater diagnostic yield or positive predictive value. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Incidence of delayed hair re-growth, pruritus, and urinary retention after epidural anaesthesia in dogs.

PubMed

Kalchofner Guerrero, K S; Guerrero, T G; Schweizer-Kölliker, M; Ringer, S K; Hässig, M; Bettschart-Wolfensberger, R

2014-04-16

Delayed hair re-growth, pruritus and urinary retention are known complications after epidural anaesthesia in dogs. The aim of this study was to prospectively evaluate the effect of epidurally administered drugs on the occurrence of these complications in dogs. Ninety dogs were included in this study. Eighty client-owned dogs undergoing surgery were randomly assigned to one of three epidural treatment groups: either morphine and bupivacaine (MB), bupivacaine (B), or saline solution 0.9% (S) was administered epidurally to these patients. Ten dogs were only clipped in the lumbosacral area (C). Follow-up started 4 weeks after clipping and was performed every 4-5 weeks in cases of delayed hair re-growth or pruritus. Hair re-growth in the lumbosacral area was observed and compared to hair re-growth in the surgical field and the fentanyl patch area. Cytological analysis and a trichogram were performed if hair re-growth was delayed after 6 months. Time interval to first urination postoperatively was recorded (n = 80). Hair re-growth was delayed in 11 dogs (12.2%; B: n = 7, S: n = 2, MB: n = 1, C: n = 1) with no differences between groups. Pruritus was evident in two dogs (2.2%; MB: n = 1, S: n = 1). After 6 months, hair had started to re-grow in all but one dog (B). After 10 months the coat of this dog had re-grown. Time to first urination did not differ between groups. No direct correlation between the particular drugs injected epidurally and delayed hair re-growth, pruritus and urinary retention could be shown. Dog owners should be informed that hair re-growth after epidural anaesthesia could be markedly delayed.

Morphine Spinal Block Anesthesia in Patients Who Undergo an Open Hemorrhoidectomy: A Prospective Analysis of Pain Control and Postoperative Complications

PubMed Central

Moreira, José PT; Isaac, Raniere R; Alves-Neto, Onofre; Moreira, Thiago AC; Vieira, Tiago HM; Brasil, Andressa MS

2014-01-01

Purpose This study evaluated the use of adding morphine to bupivacaine in spinal anesthesia for pain control in patients who underwent an open hemorrhoidectomy. Methods Forty patients were prospectively selected for an open hemorrhoidectomy at the same institution and were randomized into two groups of 20 patients each: group 1 had a spinal with 7 mg of heavy bupivacaine associated with 80 µg of morphine (0.2 mg/mL). Group 2 had a spinal with 7 mg of heavy bupivacaine associated with distilled water, achieving the same volume of spinal infusion as that of group 1. Both groups were prescribed the same pain control medicine during the postoperative period. Pain scores were evaluated at the anesthetic recovery room and at 3, 6, 12, and 24 hours after surgery. Postoperative complications, including pruritus, nausea, headaches, and urinary retention, were also recorded. Results There were no anthropometric statistical differences between the two groups. Pain in the anesthetic recovery room and 3 hours after surgery was similar for both groups. However, pain was better controlled in group 1 at 6 and 12 hours after surgery. Although pain was better controlled for group 1 after 24 hours of surgery, the difference between the groups didn't achieved statistical significance. Complications were more common in group 1. Six patients (6/20) presented coetaneous pruritus and 3 with (3/20) urinary retention. Conclusion A hemorrhoidectomy under a spinal with morphine provides better pain control between 6 and 12 hours after surgery. However, postoperative complications, including cutaneous pruritus (30%) and urinary retention (15%), should be considered as a negative side of this procedure. PMID:24999465

78 FR 40149 - Scientific Information Request on Chronic Urinary Retention (CUR) Treatment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-03

... improve the quality of this review. AHRQ is conducting this comparative effectiveness review pursuant to..., study period, design, methodology, indication and diagnosis, proper use instructions, inclusion and... study number, the study period, design, methodology, indication and diagnosis, proper use instructions...

Comparison between three mini-sling surgical procedures and the traditional transobturator vaginal tape technique for female stress urinary incontinence

PubMed Central

LEANZA, V.; INTAGLIATA, E.; LEANZA, A.; FERLA, F.; LEANZA, G.; VECCHIO, R.

2014-01-01

Objectives To compare mini-sling and traditional tension-free operations for female stress urinary incontinence. Study design A systematic review of articles in the Literature published between 2002 and 2012, was conducted. A Pubmed search was performed. Primary outcomes were subjective and objective cure rates at 12 months comparing the three single-incision mini-slings techniques (TVT-Secur, MiniArc and Monarc systems) with the standard mid-urethral sling procedure TOT (Transobturator Vaginal Tape). Secondary outcomes included peri-operative (vaginal and/or bladder perforation, urine retention, urinary tract infection, bleeding, pain) and post-operative (mesh exposure, de novo urgency, and dyspareunia) complications. Results In term of objective cure rate at 12 month after surgery, it is evident that TOT at first, and MiniArc are the most effective procedures. The incidence of post-operative urgency and UTI was lower in TOT technique, while vaginal perforation was described in equal frequency both in TOT and in MiniArc procedures. The advantages of the three above described mini-invasive techniques seem to consist into lower cases of urinary retention, pain and bleeding. Furthermore, bladder perforation and bleeding are not described in the Literature for TVT-Secur and Monarc systems. Conclusions Some single-incision slings look promising and as effective as conventional sub-urethral slings at short term evaluation. However, at this moment a clear statement in favor of the widespread use of single-incision slings cannot be made. More studies must define the efficacy of these techniques. PMID:24841685

EDTA chelation effects on urinary losses of cadmium, calcium, chromium, cobalt, copper, lead, magnesium, and zinc.

PubMed

Waters, R S; Bryden, N A; Patterson, K Y; Veillon, C; Anderson, R A

2001-12-01

The efficacy of a chelating agent in binding a given metal in a biological system depends on the binding constants of the chelator for the particular metals in the system, the concentration of the metals, and the presence and concentrations of other ligands competing for the metals in question. In this study, we make a comparison of the in vitro binding constants for the chelator, ethylenediaminetetraacetic acid, with the quantitative urinary excretion of the metals measured before and after EDTA infusion in 16 patients. There were significant increases in lead, zinc, cadmium, and calcium, and these increases roughly corresponded to the expected relative increases predicted by the EDTA-metal-binding constants as measured in vitro. There were no significant increases in urinary cobalt, chromium, or copper as a result of EDTA infusion. The actual increase in cobalt could be entirely attributed to the cobalt content of the cyanocobalamin that was added to the infusion. Although copper did increase in the post-EDTA specimens, the increase was not statistically significant. In the case of magnesium, there was a net retention of approximately 85% following chelation. These data demonstrate that EDTA chelation therapy results in significantly increased urinary losses of lead, zinc, cadmium, and calcium following EDTA chelation therapy. There were no significant changes in cobalt, chromium, or copper and a retention of magnesium. These effects are likely to have significant effects on nutrient concentrations and interactions and partially explain the clinical improvements seen in patients undergoing EDTA chelation therapy.

Postoperative Complications Associated With rhBMP2 Use in Posterior/Posterolateral Lumbar Fusion.

PubMed

Esmail, Nabil; Buser, Zorica; Cohen, Jeremiah R; Brodke, Darrel S; Meisel, Hans-Joerg; Park, Jong-Beom; Youssef, Jim A; Wang, Jeffrey C; Yoon, S Tim

2018-04-01

Retrospective database review. Posterior/posterolateral lumbar fusion (PLF) is an effective treatment for a variety of spinal disorders; however, variations in surgical technique have different complication profiles. The aim of our study was to quantify the frequency of various complications in patients undergoing PLF with and without human recombinant bone morphogenetic protein 2 (rhBMP2). We queried the orthopedic subset of the Medicare database (PearlDiver) between 2005 and 2011 for patients undergoing PLF procedures with and without rhBMP2. Complication and reoperation rates were analyzed within 1 year of the index procedure. Complications assessed include: acute renal failure, deep vein thrombosis, dural tear, hematoma, heterotopic ossification, incision and drainage, cardiac complications, nervous system complications, osteolysis, pneumonia, pseudarthrosis, pulmonary embolism, radiculopathy, respiratory complications, sepsis, urinary retention, urinary tract infection, mechanical, and wound complications. Chi-square analysis was used to calculate the complication differences between the groups. Our data revealed higher overall complication rates in patients undergoing PLF with rhBMP2 versus no_rhBMP2 (76.9% vs 68.8%, P < .05). Stratified by gender, rhBMP2 males had higher rates of mechanical complications, pseudarthrosis, and reoperations compared with no_rhBMP2 males ( P < .05), whereas rhBMP2 females had higher rates of pseudarthrosis, urinary tract infection, and urinary retention compared with no_rhBMP2 females ( P < .05). Our data revealed higher overall complication rates in PLF patients given rhBMP2 compared with no_rhBMP2. Furthermore, our data suggests that rhBMP2-associated complications may be gender specific.

Urinary Retention, Incontinence, and Dysregulation of Muscarinic Receptors in Male Mice Lacking Mras.

PubMed

Ehrhardt, Annette; Wang, Bin; Yung, Andrew C; Wang, Yanni; Kozlowski, Piotr; van Breemen, Cornelis; Schrader, John W

2015-01-01

Here we show that male, but not female mice lacking expression of the GTPase M-Ras developed urinary retention with distention of the bladder that exacerbated with age but occurred in the absence of obvious anatomical outlet obstruction. There were changes in detrusor morphology in Mras-/- males: Smooth muscle tissue, which exhibited a compact organization in WT mice, appeared disorganized and became increasingly 'layered' with age in Mras-/- males, but was not fibrotic. Bladder tissue near the apex of bladders of Mras-/- males exhibited hypercontractility in response to the cholinergic agonist carbachol in in vitro, while responses in Mras-/- females were normal. In addition, spontaneous phasic contractions of detrusors from Mras-/- males were increased, and Mras-/- males exhibited urinary incontinence. We found that expression of the muscarinic M2 and M3 receptors that mediate the cholinergic contractile stimuli of the detrusor muscle was dysregulated in both Mras-/- males and females, although only males exhibited a urinary phenotype. Elevated expression of M2R in young males lacking M-Ras and failure to upregulate M3R with age resulted in significantly lower ratios of M3R/M2R expression that correlated with the bladder abnormalities. Our data suggests that M-Ras and M3R are functionally linked and that M-Ras is an important regulator of male bladder control in mice. Our observations also support the notion that bladder control is sexually dimorphic and is regulated through mechanisms that are largely independent of acetylcholine signaling in female mice.

Urinary Retention, Incontinence, and Dysregulation of Muscarinic Receptors in Male Mice Lacking Mras

PubMed Central

Ehrhardt, Annette; Wang, Bin; Yung, Andrew C.; Wang, Yanni; Kozlowski, Piotr; van Breemen, Cornelis; Schrader, John W.

2015-01-01

Here we show that male, but not female mice lacking expression of the GTPase M-Ras developed urinary retention with distention of the bladder that exacerbated with age but occurred in the absence of obvious anatomical outlet obstruction. There were changes in detrusor morphology in Mras -/- males: Smooth muscle tissue, which exhibited a compact organization in WT mice, appeared disorganized and became increasingly ‘layered’ with age in Mras -/- males, but was not fibrotic. Bladder tissue near the apex of bladders of Mras -/- males exhibited hypercontractility in response to the cholinergic agonist carbachol in in vitro, while responses in Mras -/- females were normal. In addition, spontaneous phasic contractions of detrusors from Mras -/- males were increased, and Mras -/- males exhibited urinary incontinence. We found that expression of the muscarinic M2 and M3 receptors that mediate the cholinergic contractile stimuli of the detrusor muscle was dysregulated in both Mras -/- males and females, although only males exhibited a urinary phenotype. Elevated expression of M2R in young males lacking M-Ras and failure to upregulate M3R with age resulted in significantly lower ratios of M3R/M2R expression that correlated with the bladder abnormalities. Our data suggests that M-Ras and M3R are functionally linked and that M-Ras is an important regulator of male bladder control in mice. Our observations also support the notion that bladder control is sexually dimorphic and is regulated through mechanisms that are largely independent of acetylcholine signaling in female mice. PMID:26516777

Nonkeratinised Squamous Metaplasia of the Urinary Bladder in Children: A Report of Case Experiences

PubMed Central

Jurkiewicz, Beata

2014-01-01

Background. Squamous metaplasia refers to the pathological transformation of the urothelium leading to nonkeratinised stratified squamous metaplasia (N-KSM). Objective. To present our experiences in the diagnosis and treatment of N-KSM of the urinary bladder in children. Materials and Methods. In this study, we present our experiences in the diagnosis and treatment of N-KSM of the urinary bladder in children aged from 5 to 17 years. From 2005 to 2013, metaplasia was diagnosed in 119 patients. The reasons behind visiting the hospital were nonspecific intense pain in the abdomen, recurrent urinary tract infections, and urination disorders. The most common symptoms of urinary bladder dysfunction were pollakiuria and difficulties in initiating micturition and retention of urine (reduced detrusor muscle activity). Results. In 20/119 patients (16.8%), metaplasia was incidentally diagnosed during cystoscopy performed for other causes. The changes characteristic for squamous metaplasia were diagnosed—in all these patients, a biopsy was performed. In all 119 patients, a squamous metaplasia was histopathologically diagnosed. Conclusions. Squamous metaplasia of the urinary bladder mucosa occurs in children and adolescents. Symptomatic treatment is administered mainly to improve the patients' quality of life and disease prognosis. PMID:24822222

[Recurrent urinary tract infection due to enterovesical fistula secondary to colon diverticular disease: a case report].

PubMed

Cavalcanti, Natália Silva; da Silva, Lorena Luryann Cartaxo; da Silva, Leonardo Sales; da Fonseca, Luiz Antonio Cavalcante; Alexandre, Cristianne da Silva

2013-01-01

Enterovesical fistula are pathological connections between the bladder and pelvic intestinal segments. It consists of a rare complication of neoplastic and inflammatory pelvic disorders, in addition to iatrogenic or traumatic injuries, and correlates with both high morbidity and mortality indexes. Male patient, 61 years old, admitted at the hospital clinics featuring abdominal pain and distension, vomiting and fecal retention. Patient's pathological precedents include high blood pressure, diabetes mellitus, vesical dysfunction and recurrent urinary tract infection on the past three years. Magnetic resonance imaging of abdomen and pelvis revealed enterovesical fistula in association with colon diverticular disease of the sigmoid. Management of choice consisted of partial colectomy with bowel lowering and partial cystectomy with surgical double-J stent insertion. Although consisting of a gastrointestinal primary affection, patients with enterovesical fistula usually search for medical help charging urinary tract features. In this particular case, our patient was admitted with gastrointestinal symptoms, reasoned by diagnostic delay, as the patient had already attended at multiple centers with urinary symptoms. Despite being an unusual affection, recurrent urinary tract infection associated with colon diverticular disease must always be considered at differential diagnosis of recurrent urinary tract infection as it concurs with high morbidity and mortality.

Early complications with the holmium laser

NASA Astrophysics Data System (ADS)

Beaghler, Marc A.; Stewart, Steven C.; Ruckle, Herbert C.; Poon, Michael W.

1997-05-01

The purpose of this study is to report early complications in our initial experience with the holmium laser in 133 patients. A retrospective study of patients undergoing endourological procedures with the holmium laser was performed. Complications included urinary tract infection (3), post-operative bradycardia (1), inverted T-waves (1), intractable flank pain (1), urinary retention (1), inability to access a lower pole calyx with a 365 micron fiber (9), stone migration (5), termination of procedure due to poor visualization (2). No ureteral perforations or strictures occurred. The holmium laser was capable of fragmenting all urinary calculi in this study. In our initial experience, the holmium laser is safe and effective in the treatment of genitourinary pathology. Use of laser fibers larger than 200 microns occasionally limit deflection into a lower pole or dependent calyx.

Clinical analysis of urinary tract infection in patients undergoing transurethral resection of the prostate.

PubMed

Li, Y-H; Li, G-Q; Guo, S-M; Che, Y-N; Wang, X; Cheng, F-T

2017-10-01

To analyze the related influencing factors of urinary tract infection in patients undergoing transurethral resection of the prostate (TURP). A total of 343 patients with benign prostatic hyperplasia admitted to this hospital from January 2013 to December 2016, were selected and treated by TURP. Patients were divided into infection group and non-infection group according to the occurrence of urinary tract infection after operation. The possible influencing factors were collected to perform univariate and multivariate logistic regression analysis. There were 53 cases with urinary tract infection after operation among 343 patients with benign prostatic hyperplasia, accounting for 15.5%. The univariate analysis displayed that the occurrence of urinary tract infection in patients undergoing TURP was closely associated with patient's age ≥ 65 years old, complicated diabetes, catheterization for urinary retention before operation, no use of antibiotics before operation and postoperative indwelling catheter duration ≥ 5 d (p < 0.05). Multivariate logistic regression analysis revealed that age ≥ 65 years old, complicated diabetes, catheterization before operation, indwelling catheter duration ≥ 5 d and no use of antibiotics before operation were risk factors of urinary tract infection in patients receiving TURP (p < 0.05). The patient's age ≥ 65 years old, catheterization before operation, complicated diabetes and long-term indwelling catheter after operation, can increase the occurrence of urinary tract infection after TURP, while preoperative prophylactic utilization of anti-infective drugs can reduce the occurrence of postoperative urinary tract infection.

Actinobaculum schaalii, a new cause of knee prosthetic joint infection in elderly.

PubMed

Jacquier, H; Benmansour, H; Zadegan, F; Hannouche, D; Micaelo, M; Mongiat-Artus, P; Salomon, E; Cambau, E; Berçot, B

2016-08-01

Actinobaculum schaalii is an emerging pathogen particularly involved in urinary tract infection of elderly people and/or patient with urological risk factors of urinary tract infection. This microorganism is a difficult-to-diagnose pathogen and is rarely involved in systemic or deep infections. Here, we report the first case of prosthetic joint infection due to A. schaalii in an 84-year-old man with a benign prostatic hyperplasia associated with chronic retention of urine. This case underlines the importance to optimize the diagnosis of emerging uropathogens as A. schaalii, to prevent systemic infections, particularly in patients with orthopaedic implants.

Quantification of absorption, retention and elimination of two different oral doses of vitamin A in Zambian boys using accelerator mass spectrometry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aklamati, E K; Mulenga, M; Dueker, S R

A recent survey indicated that high-dose vitamin A supplements (HD-VAS) had no apparent effect on vitamin A (VA) status of Zambian children <5 y of age. To explore possible reasons for the lack of response to HD-VAS among Zambian children, we quantified the absorption, retention, and urinary elimination of either a single HDVAS (60 mg) or a smaller dose of stable isotope (SI)-labeled VA (5 mg), which was used to estimate VA pool size, in 3-4 y old Zambian boys (n = 4 for each VA dose). A 25 nCi tracer dose of [{sup 14}C{sub 2}]-labeled VA was co-administered withmore » the HD-VAS or SI-labeled VA, and 24-hr stool and urine samples were collected for 3 and 7 consecutive days, respectively, and 24-hr urine samples at 4 later time points. Accelerator Mass Spectrometry (AMS) was used to measure the cumulative excretion of {sup 14}C in stool and urine 3d after dosing to estimate, respectively, absorption and retention of the VAS and SI-labeled VA. The urinary elimination rate (UER) was estimated by plotting {sup 14}C in urine vs. time, and fitting an exponential equation to the data. Estimates of mean absorption, retention and the UER were 83.8 {+-} 7.1%, 76.3 {+-} 6.7%, and 1.9 {+-} 0.6%/d, respectively, for the HD-VAS and 76.5 {+-} 9.5%, 71.1 {+-} 9.4%, and 1.8 {+-} 1.2%/d, respectively for the smaller dose of SI-labeled VA. Estimates of absorption, retention and the UER did not differ by size of the VA dose administered (P=0.26, 0.40, 0.88, respectively). Estimated absorption and retention were negatively associated with reported fever (P=0.011) and malaria (P =0.010). HD-VAS and SI-labeled VA were adequately absorbed, retained and utilized in apparently healthy Zambian preschool-age boys, although absorption and retention may be affected by recent infections.« less

Office evaluation of male patients with lower urinary tract symptoms.

PubMed

Tabatabaei, Shahin; Talab, Saman Shafaat; Zangi, Mahdi; Woo, Henry H

2012-12-01

Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) are one of the most common urologic disorders in men. Accurate history-taking and focused physical examination allows us to diagnose the majority of cases. A better understanding of risk factors helps us tailor our treatment and predict outcomes more accurately. Population studies are crucial in our understanding of LUTS/BPH natural history. Temporary prostatic urethral stents that are used for the management of urinary retention may also be used for evaluation of patients with detrusor hypo-contractility. The use of ultrasound to measure intravesical prostatic protrusion (IPP) and the Doppler study for prostate capsular artery resistive index are promising. Near-infrared spectroscopy (NIRS) examines the tissue oxygenation that may be affected by bladder outlet obstruction. The mathematical algorithm needs some fine-tuning, and its reproducibility is debatable. Serum and urinary biomarkers may help us to diagnose the disorder, and more effectively monitor patients' response to therapy. Among all, IPP is clinically more applicable at this time.

Bladder necrosis: 'A man without a bladder'.

PubMed

Bosschieter, Judith; Oudshoorn, Frederik H K; Meuleman, Eric J H; Nieuwenhuijzen, Jakko A

2018-02-17

Since the use of antibiotics, bladder necrosis has become a rare condition. We report a case of bladder necrosis in a 90-year-old man following urinary retention. After insertion of a transurethral catheter (TUC), 2 L of urine was evacuated. In the following days, the TUC became intermittently blocked. Adequate bladder drainage could not be obtained despite intensive rinsing and placement of a suprapubic catheter. On surgical exploration necrosis of almost the entire bladder wall, except for the trigone, was encountered. Surgical debridement of the non-viable bladder wall without opening the abdominal cavity was conducted, and a TUC was placed in the Retzius cavity to ensure evacuation of urine. Since the patient was haemodynamically unstable, construction of a urinary diversion was waived and urinary drainage of the Retzius cavity by the TUC was accepted, resulting in adequate urinary drainage without compromising renal function. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Sacral Nerve Stimulation for Pediatric Lower Urinary Tract Dysfunction: Development of a Standardized Pathway with Objective Urodynamic Outcomes.

PubMed

Schober, Megan S; Sulkowski, Jason P; Lu, Peter L; Minneci, Peter C; Deans, Katherine J; Teich, Steven; Alpert, Seth A

2015-12-01

We propose that sacral nerve stimulation is a valid adjunctive therapy for refractory pediatric lower urinary tract dysfunction, and that prospective collection of preoperative and postoperative validated questionnaires and urodynamic data in a standardized fashion is beneficial in characterizing patient response. Patients were candidates for sacral nerve stimulation if they had refractory voiding dysfunction and standard treatments had failed. Preoperative evaluation included urodynamic studies, spinal magnetic resonance imaging, and validated bladder and bowel related questionnaires. Children were stratified into 2 groups, ie overactive bladder with or without incontinence (group 1) and detrusor underactivity/urinary retention requiring clean intermittent catheterization (group 2). A staged procedure was used with initial test lead placement, followed by permanent device insertion 2 weeks later if patients demonstrated symptom improvement with test lead. Postoperatively children were followed with questionnaires and at least 1 urodynamic study. A total of 26 children underwent sacral nerve stimulation. Mean patient age was 10.8 years and median followup was 1.2 years. There were 23 patients in group 1 and 4 in group 2 (1 patient was included in both groups). In group 1 voiding dysfunction scores improved significantly, and urodynamic studies revealed a significant decrease in mean number of uninhibited contractions and maximum detrusor pressure during the filling phase. In group 2 there was significant improvement in mean post-void residual. Sacral nerve stimulation is a treatment option that may produce significant improvement in objective and subjective measures of bladder function in children with refractory lower urinary tract dysfunction. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Herpes zoster producing temporary erectile dysfunction.

PubMed

Rix, G H; Carroll, D N; MacFarlane, J R

2001-12-01

Varicella Zoster affecting the sacral dermatomes is a rare but well recognised cause of urinary retention. Only one case of erectile dysfunction associated with Varicella Zoster has previously been described, which was longstanding, but no cases of transient erectile dysfunction following Zoster infection are recorded. We present one such case.

AdVance male sling

PubMed Central

Chung, Amanda S. J.; Suarez, Oscar A.

2017-01-01

The AdVance sling (American Medical Systems, Minnetonka, MN, United States of America) is a synthetic transobturator sling, which is a safe and effective minimally invasive treatment for mild to moderate stress urinary incontinence (SUI) in male patients. This article provides a step-by-step description of our technique for placement of the AdVance male sling, including details and nuances gained from surgical experience, advice for avoidance of complications and discussion on management of complications and sling failures. Patient selection is very important, including exclusion and preoperative treatment of urethral stenosis and bladder dysfunction. Previous pelvic radiation is a poor prognostic factor. In brief, the steps of sling placement are: (I) mobilization of the corpus spongiosum (CS); (II) marking and mobilization of the central tendon; (III) passage of the helical trocar needles exiting at the apex of the angle between the CS and inferior pubic ramus; (IV) fixation of the broad part of the sling body to the CS at the previous mark; (V) cystoscopy during sling tensioning; (VI) placement of a Foley urethral catheter; (VII) Subcutaneous tunnelling of the sling arms back toward the midline; (VIII) wound closure. The most common early postoperative complication is urinary retention but long-term retention is extremely rare. Management of sling failures include placement of an artificial urinary sphincter, repeat AdVance sling, urethral bulking agent or ProACT device. PMID:28904900

Urological complications of uterine leiomyoma: a review of literature.

PubMed

Dagur, Gautam; Suh, Yiji; Warren, Kelly; Singh, Navjot; Fitzgerald, John; Khan, Sardar A

2016-06-01

Uterine leiomyomas are common gynecologic tumor in reproductive-aged women, by age 50, diagnosis shared by urologist, gynecologists and radiologists. The goal of this article is to review the current literature, study the impact of leiomyoma on female lower urinary tract, examine the cause female sexual dysfunction and provide a comprehensive review of current diagnostic, imaging studies, and current treatment of leiomyoma. Clinical leiomyoma studies published from 1956 through 2015 were identified using the PubMed search engines and the key words leiomyoma, fibroid in the current literature. Impact of leiomyoma on the lower urinary tract including female sexual dysfunction was reviewed with terms of "urinary retention", "bladder", "urethra", "dyspareunia", "incontinence", "incomplete bladder emptying", "female sexual dysfunction", and "lower urinary tract" to study the urological and sexual effects of leiomyoma. Literature related to leiomyoma was reviewed from 1965 to present. Women with uterine leiomyomata complained of pelvic pain, menstrual irregularities, infertility, lower urinary tract symptoms and sexual dysfunction. Leiomyoma is a common tumor of the uterus that often clinically impacts on the lower urinary tract and results in urological and sexual symptoms. Leiomyoma can compress and grow into and become adherent to the bladder and surrounding pelvic organs or metastasize into peritoneal organs. Leiomyoma can enlarge and compress the urinary bladder, urethra, and lower end of the ureters. Leiomyoma can cause embarrassing sexual dysfunction in females. Current literature of non-surgical and surgical therapy of leiomyoma is described.

Associations between lower urinary tract dysfunction and glycemic control in women with type 2 diabetes: A cross-sectional study.

PubMed

Tai, Huai-Ching; Tai, Tong-Yuan; Yang, Wei-Shiung; Wang, Shin-Wei; Yu, Hong-Jeng

2016-04-01

Patients with diabetes are predisposed to develop a variety of complications, including lower urinary tract (LUT) dysfunction. We aimed to examine the associations between glycemic control and LUT dysfunction in women with type 2 diabetes (T2D). We included 400 women with T2D (age range, 48-75 years) in this cross-sectional analysis. The participants were divided into tertiles according to glycosylated hemoglobin (HbA1c) measurements. The mean HbA1c levels for tertiles 1, 2, and 3 were 6.2% (N=132), 7.1% (N=132), and 8.4% (N=136), respectively. We evaluated LUT dysfunction with the American Urological Association Symptom Index (AUA-SI) questionnaire, uroflowmetry (UFM), and post-void residual (PVR). No significant differences were found among HbA1c tertiles regarding storage, voiding and total AUA-SI scores, and prevalence of LUT symptoms. However, women in tertile 3 had higher prevalences of severe LUT symptoms (AUA-SI≥20) and clinically significant PVR (≥100mL) compared to women in the other tertiles. Multivariate analysis revealed that diabetic neuropathy, but not HbA1c, significantly predicted LUT symptoms in women with T2D after adjustment for age, body mass index (BMI) and hypertension. However, HbA1c was associated with an increased risk of developing clinically significant PVR. Our findings do not support significant associations between glycemic control and LUT symptoms in women with T2D. However, women with poor glycemic control are more likely to develop urinary retention than women with proper glycemic control. Clinicians should, therefore, be aware of and educate patients about the association between urinary retention and glycemic control. Copyright © 2016 Elsevier Inc. All rights reserved.

Social stress in mice induces voiding dysfunction and bladder wall remodeling

PubMed Central

Chang, Andy; Butler, Stephan; Sliwoski, Joanna; Valentino, Rita; Canning, Douglas

2009-01-01

Several studies have anecdotally reported the occurrence of altered urinary voiding patterns in rodents exposed to social stress. A recent study characterized the urodynamic and central changes in a rat model of social defeat. Here, we describe a similar voiding phenotype induced in mice by social stress and in addition we describe potential molecular mechanisms underlying the resulting bladder wall remodeling. The mechanism leading to the altered voiding habits and underlying bladder phenotype may be relevant to the human syndrome of dysfunctional voiding which is thought to have a psychological component. To better characterize and investigate social stress-induced bladder wall hypertrophy, FVB mice (6 wk old) were randomized to either social stress or control manipulation. The stress involved repeated cycles of a 1-h direct exposure to a larger aggressive C57Bl6 breeder mouse followed by a 23-h period of barrier separation over 4 wk. Social stress resulted in altered urinary voiding patterns suggestive of urinary retention and increased bladder mass. In vivo cystometry revealed an increased volume at micturition with no change in the voiding pressure. Examination of these bladders revealed increased nuclear expression of the transcription factors MEF-2 and NFAT, as well as increased expression of the myosin heavy chain B isoform mRNA. BrdU uptake was increased within the urothelium and lamina propria layers in the social stress group. We conclude that social stress induces urinary retention that ultimately leads to shifts in transcription factors, alterations in myosin heavy chain isoform expression, and increases in DNA synthesis that mediate bladder wall remodeling. Social stress-induced bladder dysfunction in rodents may provide insight into the underlying mechanisms and potential treatment of dysfunctional voiding in humans. PMID:19587139

Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rampoldi, Antonio; Barbosa, Fabiane, E-mail: fabiane001@hotmail.com; Secco, Silvia

PurposeTo prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates.MethodsPatients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality ofmore » life, prostate size and uroflowmetric parameters.ResultsA total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome.ConclusionsPAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without surgical treatment options.« less

Postoperative Complications Associated With rhBMP2 Use in Posterior/Posterolateral Lumbar Fusion

PubMed Central

Esmail, Nabil; Buser, Zorica; Cohen, Jeremiah R.; Brodke, Darrel S.; Meisel, Hans-Joerg; Park, Jong-Beom; Youssef, Jim A.; Wang, Jeffrey C.; Yoon, S. Tim

2017-01-01

Study Design: Retrospective database review. Objective: Posterior/posterolateral lumbar fusion (PLF) is an effective treatment for a variety of spinal disorders; however, variations in surgical technique have different complication profiles. The aim of our study was to quantify the frequency of various complications in patients undergoing PLF with and without human recombinant bone morphogenetic protein 2 (rhBMP2). Methods: We queried the orthopedic subset of the Medicare database (PearlDiver) between 2005 and 2011 for patients undergoing PLF procedures with and without rhBMP2. Complication and reoperation rates were analyzed within 1 year of the index procedure. Complications assessed include: acute renal failure, deep vein thrombosis, dural tear, hematoma, heterotopic ossification, incision and drainage, cardiac complications, nervous system complications, osteolysis, pneumonia, pseudarthrosis, pulmonary embolism, radiculopathy, respiratory complications, sepsis, urinary retention, urinary tract infection, mechanical, and wound complications. Chi-square analysis was used to calculate the complication differences between the groups. Results: Our data revealed higher overall complication rates in patients undergoing PLF with rhBMP2 versus no_rhBMP2 (76.9% vs 68.8%, P < .05). Stratified by gender, rhBMP2 males had higher rates of mechanical complications, pseudarthrosis, and reoperations compared with no_rhBMP2 males (P < .05), whereas rhBMP2 females had higher rates of pseudarthrosis, urinary tract infection, and urinary retention compared with no_rhBMP2 females (P < .05). Conclusion: Our data revealed higher overall complication rates in PLF patients given rhBMP2 compared with no_rhBMP2. Furthermore, our data suggests that rhBMP2-associated complications may be gender specific. PMID:29662744

Urinary catheters: history, current status, adverse events and research agenda

PubMed Central

Feneley, Roger C. L.; Hopley, Ian B.; Wells, Peter N. T.

2015-01-01

Abstract For more than 3500 years, urinary catheters have been used to drain the bladder when it fails to empty. For people with impaired bladder function and for whom the method is feasible, clean intermittent self-catheterization is the optimal procedure. For those who require an indwelling catheter, whether short- or long-term, the self-retaining Foley catheter is invariably used, as it has been since its introduction nearly 80 years ago, despite the fact that this catheter can cause bacterial colonization, recurrent and chronic infections, bladder stones and septicaemia, damage to the kidneys, the bladder and the urethra, and contribute to the development of antibiotic resistance. In terms of medical, social and economic resources, the burden of urinary retention and incontinence, aggravated by the use of the Foley catheter, is huge. In the UK, the harm resulting from the use of the Foley catheter costs the National Health Service between £1.0–2.5 billion and accounts for ∼2100 deaths per year. Therefore, there is an urgent need for the development of an alternative indwelling catheter system. The research agenda is for the new catheter to be easy and safe to insert, either urethrally or suprapubically, to be retained reliably in the bladder and to be withdrawn easily and safely when necessary, to mimic natural physiology by filling at low pressure and emptying completely without damage to the bladder, and to have control mechanisms appropriate for all users. PMID:26383168

Intermittent catheterization with hydrophilic catheters as a treatment of chronic neurogenic urinary retention.

PubMed

Chartier-Kastler, Emmanuel; Denys, Pierre

2011-01-01

Neurogenic bladder can be effectively managed with intermittent catheterization (IC) to improve or restore continence, but there is no consensus on which type of catheter is preferred. Hydrophilic catheters were developed to reduce urethral friction, thereby minimizing trauma and sticking, and making them more acceptable to the patient, and easier and safer to use. The objective of this article was to review the literature on the benefits of hydrophilic catheters in patients with neurogenic bladder. A large body of experimental and observational evidence, including randomized controlled trials, was identified using PubMed. Compared with plastic catheters that have been manually lubricated with gel, hydrophilic catheters reduce urinary tract infection and microhematuria. Hydrophilic catheters are also associated with high levels of patient satisfaction because they are comfortable to use. There is a wealth of evidence, including randomized controlled trials, to support the benefits of hydrophilic catheters in terms of safety and quality of life, especially in men with spinal cord injury. More data are required for spina bifida, multiple sclerosis, and in women. Further research is warranted, especially large-scale and long-term robust comparisons of different types of catheter, and in well-defined and stratified populations. Copyright © 2010 Wiley-Liss, Inc.

A clinical audit of postoperative urinary retention in the postanesthesia care unit.

PubMed

McLeod, Laura; Southerland, Kerry; Bond, Jade

2013-08-01

Postoperative urinary retention (PUR) is a common postsurgical complication. Early detection and management of PUR is of particular concern to nurses working in the postanesthesia care unit (PACU) because a single episode of bladder distention may result in permanent bladder damage. A clinical audit (CA) was conducted that examined the risk factors that may contribute to the development of PUR in the PACU. The CA was conducted over a 1-week time period and used a data collection tool that was developed from the current literature. A total of 34 patients met the inclusion criteria for the CA, and a prevalence rate of 20.6% was reported, which was consistent with prevalence rates reported by larger research studies. Despite the small sample size of this CA, results suggested that PUR should be of concern to nurses in the PACU. Recommendations included the development and implementation of a guideline relating to bladder scanning in the PACU and modification of existing PACU discharge criteria to include bladder management. Copyright © 2013 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Effect of dietary fiber and crude protein content in feed on nitrogen retention in pigs.

PubMed

Patrás, P; Nitrayová, S; Brestenský, M; Heger, J

2012-12-01

Eight gilts (29.9 ± 1.7 kg initial BW) were used to evaluate effects of dietary (crude) fiber on N excretion via feces and urine at 2 levels of dietary CP. Pigs were fed 4 dietary treatments according to a double 4 × 4 Latin square. Treatments were low (14%) CP and low (3.25%) (crude) fiber (LPAA), low CP and high (4.46%) fiber (LPAABP), high (18.8%) CP and low fiber (HP), and high CP and high fiber (HPBP). Diets were based on soybean (Glycine max) meal, wheat (Triticum aestivum), and maize (Zea mays) and were supplemented with crystalline AA. High fiber diets contained 15% dried beet (Beta vulgaris) pulp. Pigs were housed in metabolic cages and fed 2 equal meals at 0700 and 1700 h at a daily rate of 90 g/kg BW(0.75). Water was offered ad libitum. Each experimental period consisted of a 6-d adaptation followed by a 4-d collection of feces and urine (bladder catheters). Data were analyzed using ANOVA. Differences between means (P < 0.05) were assessed using Fisher's LSD procedure. The N intake, fecal N excretion and absorption, and N retention increased (P < 0.05) in pigs fed high-CP diets with added fiber (HP vs. HPBR). With added fiber, urinary N excretion (g/d) was reduced (P < 0.02) only for the low-CP diet. Urinary N as a percentage of N intake was reduced (P < 0.01) in both groups fed high-fiber diets irrespective of dietary CP content. Dietary fiber level did not affect DMI. Fecal DM excretion (g/d) was higher (P < 0.02) in pigs fed diets with high CP and high fiber content than in pigs fed diets with high CP and low fiber content. In conclusion, beet pulp fiber added to diets increased fecal N and reduced urinary N and in diets with higher CP content increased overall N retention.

New semi-quantitative 123I-MIBG estimation method compared with scoring system in follow-up of advanced neuroblastoma: utility of total MIBG retention ratio versus scoring method.

PubMed

Sano, Yuko; Okuyama, Chio; Iehara, Tomoko; Matsushima, Shigenori; Yamada, Kei; Hosoi, Hajime; Nishimura, Tsunehiko

2012-07-01

The purpose of this study is to evaluate a new semi-quantitative estimation method using (123)I-MIBG retention ratio to assess response to chemotherapy for advanced neuroblastoma. Thirteen children with advanced neuroblastoma (International Neuroblastoma Risk Group Staging System: stage M) were examined for a total of 51 studies with (123)I-MIBG scintigraphy (before and during chemotherapy). We proposed a new semi-quantitative method using MIBG retention ratio (count obtained with delayed image/count obtained with early image with decay correction) to estimate MIBG accumulation. We analyzed total (123)I-MIBG retention ratio (TMRR: total body count obtained with delayed image/total body count obtained with early image with decay correction) and compared with a scoring method in terms of correlation with tumor markers. TMRR showed significantly higher correlations with urinary catecholamine metabolites before chemotherapy (VMA: r(2) = 0.45, P < 0.05, HVA: r(2) = 0.627, P < 0.01) than MIBG score (VMA: r(2) = 0.19, P = 0.082, HVA: r(2) = 0.25, P = 0.137). There were relatively good correlations between serial change of TMRR and those of urinary catecholamine metabolites (VMA: r(2) = 0.274, P < 0.001, HVA: r(2) = 0.448, P < 0.0001) compared with serial change of MIBG score and those of tumor markers (VMA: r(2) = 0.01, P = 0.537, HVA: 0.084, P = 0.697) during chemotherapy for advanced neuroblastoma. TMRR could be a useful semi-quantitative method for estimating early response to chemotherapy of advanced neuroblastoma because of its high correlation with urine catecholamine metabolites.

Rapid versus gradual bladder decompression in acute urinary retention.

PubMed

Etafy, Mohamed H; Saleh, Fatma H; Ortiz-Vanderdys, Cervando; Hamada, Alaa; Refaat, Alaa M; Aal, Mohamed Abdel; Deif, Hazem; Gawish, Maher; Abdellatif, Ashraf H; Gadalla, Khaled

2017-01-01

To demonstrate a benefit in diminished adverse events such as hypotension and hematuria with gradual drainage of the bladder when compared to rapid decompression in patients with acute urinary retention (AUR) due to benign prostatic hyperplasia in a case-control study. Sixty-two patients matched our selection criteria presenting with AUR. They were divided into two groups - the first was managed by rapid drainage of the bladder, the second was managed by gradual drainage through a urethral catheter (The first 100 mL immediately evacuated, then the rest evacuated gradually over 2 h). The mean age was 64.4 and 63.2 years in the first and second group, respectively. Diagnosed cause was benign hyperplasia of the prostate. Hematuria occurred in two patients in the first group and none in the second group. The two cases of hematuria were mild and treated conservatively. After the relief of the obstruction, the mean blood pressure was noticed to decrease by 15 mmHg and 10 mmHg in the first and second group, respectively, however, no one developed significant hypotension. Pain relief was achieved after complete drainage in the first group and after the evacuation of 100 mL in the second group. We conclude that there is no significant difference between rapid and gradual decompression of the bladder in patients with AUR. Hematuria and hypotension may occur after rapid decompression of the obstructed urinary bladder, but these complications are rarely clinically significant.

Rapid versus gradual bladder decompression in acute urinary retention

PubMed Central

Etafy, Mohamed H.; Saleh, Fatma H.; Ortiz-Vanderdys, Cervando; Hamada, Alaa; Refaat, Alaa M.; Aal, Mohamed Abdel; Deif, Hazem; Gawish, Maher; Abdellatif, Ashraf H.; Gadalla, Khaled

2017-01-01

Objective: To demonstrate a benefit in diminished adverse events such as hypotension and hematuria with gradual drainage of the bladder when compared to rapid decompression in patients with acute urinary retention (AUR) due to benign prostatic hyperplasia in a case–control study. Methods: Sixty-two patients matched our selection criteria presenting with AUR. They were divided into two groups – the first was managed by rapid drainage of the bladder, the second was managed by gradual drainage through a urethral catheter (The first 100 mL immediately evacuated, then the rest evacuated gradually over 2 h). Results: The mean age was 64.4 and 63.2 years in the first and second group, respectively. Diagnosed cause was benign hyperplasia of the prostate. Hematuria occurred in two patients in the first group and none in the second group. The two cases of hematuria were mild and treated conservatively. After the relief of the obstruction, the mean blood pressure was noticed to decrease by 15 mmHg and 10 mmHg in the first and second group, respectively, however, no one developed significant hypotension. Pain relief was achieved after complete drainage in the first group and after the evacuation of 100 mL in the second group. Conclusions: We conclude that there is no significant difference between rapid and gradual decompression of the bladder in patients with AUR. Hematuria and hypotension may occur after rapid decompression of the obstructed urinary bladder, but these complications are rarely clinically significant. PMID:29118535

Exacerbation of underlying hypothyroidism caused by proteinuria and induction of urinary thyroxine loss: case report and subsequent investigation.

PubMed

Chandurkar, Vikram; Shik, John; Randell, Edward

2008-01-01

To describe a patient with excess urinary thyroxine (T4) excretion and worsening of preexisting hypothyroidism in the setting of nephrotic syndrome and to determine whether excess urinary T4 excretion is present in other patients with proteinuria. We present data regarding the patient's initial presentation, diagnostic studies, and course of her illness. We suspected urinary T4 loss to be the cause of her presentation and analyzed her urine sample for total T4. We also analyzed differences in urinary T4 excretion in 22 patients with proteinuria and 16 control patients without proteinuria. Relevant medical literature is reviewed. A 44-year-old woman presented with a 3-month history of increasing fluid retention, weight gain, and fatigue. She had long-standing hypothyroidism on a stable levothyroxine dosage, 125 mcg/d. She had gained 27 kg and had developed significant edema. She had a grossly elevated thyroid-stimulating hormone level of 91 mIU/L. Her condition worsened, and a urinary protein measurement was 14.06 g/24 h-diagnostic of nephrotic syndrome. The levothyroxine dosage was increased to 225 mcg/d. Urinary total T4 concentration in a 24-hour sample was 59.0 microg/L (83.1 microg/24 h), indicating that a substantial fraction of her orally ingested T4 was lost in urine. Urinary total T4 excretion was significantly higher in patients with proteinuria (mean +/- standard deviation, 18.0 +/- 18.2 microg/L) vs control patients without proteinuria (mean, 3.8 +/- 1.8 microg/L) (P = .0014). In the patient described, urinary T4 loss due to proteinuria and nephrotic syndrome resulted in a severe exacerbation of underlying hypothyroidism.

Near-perfect compliance with SCIP Inf-9 had no effect on catheter utilization or urinary tract infections at an academic medical center.

PubMed

Kaplan, Jennifer A; Carter, Jonathan T

2018-01-01

The Joint Commission's SCIP Inf-9 mandated early removal of indwelling urinary catheters (IUCs), but the impact of compliance on catheter-associated urinary tract infection (CAUTI) and postoperative urinary retention (POUR) are unknown. Retrospective pre- and post-intervention study at a single tertiary academic medical center of all patients undergoing general surgery procedures with an IUC placed at the time of surgery who were admitted for at least two days before and after a Best Practice Advisory was put in place to improve compliance with SCIP Inf-9. A total of 1036 patients were included (468 pre-intervention; 568 post-intervention). POUR occurred in 13% of patients and CAUTI in 0.8%. There was no change in POUR, CAUTI, or catheter utilization after the Best Practice Advisory was initiated. Both POUR and CAUTI predicted longer lengths of stay. Near-perfect SCIP Inf-9 compliance had no effect on the CAUTI rate at our institution. Copyright © 2017 Elsevier Inc. All rights reserved.

A recycling model of the biokinetics of systemic tellurium.

PubMed

Giussani, Augusto

2014-11-01

To develop a compartmental model of the systemic biokinetics of tellurium required for calculating the internal dose and interpreting bioassay measurements after incorporation of radioactive tellurium. The compartmental model for tellurium was developed with the software SAAM II v. 2.0 (©The Epsilon Group, Charlottesville, Virginia, USA). Model parameters were determined on the basis of published retention and excretion data in humans and animals. The model consists of two blood compartments, one compartment each for liver, kidneys, thyroid, four compartments for bone tissues and a generic compartment for the soft tissues. The model predicts a rapid urinary excretion of systemic tellurium: 45% in the first 24 h and 84% after 50 d. Faecal excretion amounts to 0.4% after 3 d and 9% after 50 d. Whole body retention is 55% after one day, and 2.8% after 100 d. These values as well as the retained fractions in the single organs are reasonably consistent with the available human and animal data (studies with swine and guinea pigs). The proposed model gives a realistic description of the available biokinetic data for tellurium and will be adopted by the International Commission on Radiological Protection for applications in internal dosimetry.

Transient neuropathic bladder following herpes simplex genitalis.

PubMed

Riehle, R A; Williams, J J

1979-08-01

A case of transient bladder dysfunction and urinary retention concomitant with herpes genitalis is presented. The protean manifestations of the herpes simplex virus, the similar neurotropic behavior of simplex and zoster, and the neurologic sequelae of the cutaneous simplex eruption are discussed. The possibility of sacral radiculopathy after herpes genitalis must be considered when evaluating acute or episodic neurogenic bladders.

Post Anesthesia Care Unit Patient Classification System: The Direct Care Nursing Time Component

DTIC Science & Technology

1991-07-18

Removal 1304 Enema - Cleansing 1305 Enema - Retention 1306 Colostomy - Irrigation 1307 Colostomy - Dressing Change 1308 Lavage 1309 Paracentesis 1310...Curettage 1910 Vaginal /Pelvic Ex,.iiination 1911 Urinary Bladder Training 1912 Condom Catheter Application 1913 Peritoneal Dialysis - Initiation 1914...Hypothermia/Hyperthermia Treatment 2101 Oral Medication 2102 Intramuscular Medication 2103 Subcutaneous Medication 2104 Suppository, Rectal/ Vaginal

Urinary tract infection after acute stroke: Impact of indwelling urinary catheterization and assessment of catheter-use practices in French stroke centers.

PubMed

Net, P; Karnycheff, F; Vasse, M; Bourdain, F; Bonan, B; Lapergue, B

2018-03-01

Urinary catheterization and acute urinary retention increase the risk of urinary tract infection (UTI). Our study aimed to investigate the incidence of UTI following acute stroke at our stroke center (SC) and to assess urinary catheter-care practices among French SCs. Stroke patients hospitalized within 24h of stroke onset were prospectively enrolled between May and September 2013. Neurological deficit level was assessed on admission using the US National Institutes of Health Stroke Scale (NIHSS). Patients were followed-up until discharge. Indwelling urinary catheterization (IUC) was the only technique authorized during the study. An electronic survey was also conducted among French SCs to assess their practices regarding urinary catheterization in acute stroke patients. A total of 212 patients were included, with 45 (21.2%) receiving indwelling urinary catheters. The overall estimated incidence of UTI was 14.2%, and 18% among patients receiving IUC. On univariate analysis, IUC was significantly associated with older age, longer hospital stays and higher NIHSS scores. Of the 30 SCs that responded to our survey, 19 (63.3%) declared using IUC when urinary catheterization was needed. The main argument given to justify its use was that it was departmental policy to adopt this technique. Also, 27 participants (90%) stated that conducting a study to assess the impact of urinary catheterization techniques on UTI rates in acute stroke patients would be relevant. Our results are in accord with previously reported data and confirm the high burden of UTI among acute stroke subjects. However, no association was found between IUC and UTI on univariate analysis due to a lack of statistical power. Also, our survey showed high heterogeneity in catheter-use practices among French SCs, but offered no data to help determine the best urinary catheterization technique. Urinary catheterization is common after acute stroke and a well-known risk factor of UTI. However, as high heterogeneity in catheter-use practices is found among French SCs, randomized studies comparing the efficacy of urinary catheterization techniques in terms of UTI prevention in acute stroke patients are now warranted. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

[Usefulness of urethral endoprosthesis in the management of urinary retention after brachytherapy for localized prostate cancer].

PubMed

Kerkeni, W; Chahwan, C; Lenormand, C; Dubray, B; Benyoucef, A; Pfister, C

2014-03-01

Brachytherapy is a possible treatment for localized low risk prostate cancer. Although this option is minimally invasive, some side effects may occur. Acute retention of urine (ARU) has been observed in 5% to 22% of cases and can be prevented in most cases by alpha-blocker treatment. Several alternatives have been reported in the literature for the management of ARU following brachytherapy: prolonged suprapubic catheterization, transurethral resection of the prostate and also intermittent self-catheterization. The authors report an original endoscopic approach, using urethral endoprosthesis, with a satisfactory voiding status. Copyright © 2013. Published by Elsevier Masson SAS.

Effects of varying ruminally undegradable protein supplementation on forage digestion, nitrogen metabolism, and urea kinetics in Nellore cattle fed low-quality tropical forage.

PubMed

Batista, E D; Detmann, E; Titgemeyer, E C; Valadares Filho, S C; Valadares, R F D; Prates, L L; Rennó, L N; Paulino, M F

2016-01-01

Effects of supplemental RDP and RUP on nutrient digestion, N metabolism, urea kinetics, and muscle protein degradation were evaluated in Nellore heifers () consuming low-quality signal grass hay (5% CP and 80% NDF, DM basis). Five ruminally and abomasally cannulated Nellore heifers (248 ± 9 kg) were used in a 5 × 5 Latin square. Treatments were the control (no supplement) and RDP supplementation to meet 100% of the RDP requirement plus RUP provision to supply 0, 50, 100, or 150% of the RUP requirement. Supplemental RDP (casein plus NPN) was ruminally dosed twice daily, and RUP supply (casein) was continuously infused abomasally. Jugular infusion of [NN]-urea with measurement of enrichment in urine was used to evaluate urea kinetics. The ratio of urinary 3-methylhistidine to creatinine was used to estimate skeletal muscle protein degradation. Forage NDF intake (2.48 kg/d) was not affected ( ≥ 0.37) by supplementation, but supplementation did increase ruminal NDF digestion ( < 0.01). Total N intake (by design) and N retention increased ( < 0.001) with supplementation and also linearly increased with RUP provision. Urea entry rate and gastrointestinal entry rate of urea were increased by supplementation ( < 0.001). Supplementation with RUP linearly increased ( = 0.02) urea entry rate and tended ( = 0.07) to linearly increase gastrointestinal entry rate of urea. Urea use for anabolic purposes tended ( = 0.07) to be increased by supplementation, and RUP provision also tended ( = 0.08) to linearly increase the amount of urea used for anabolism. The fraction of recycled urea N incorporated into microbial N was greater ( < 0.001) for control (22%) than for supplemented (9%) heifers. Urinary 3-methylhistidine:creatinine of control heifers was more than double that of supplemented heifers ( < 0.001). Control heifers reabsorbed a greater ( < 0.001) fraction of urea from the renal tubule than did supplemented heifers. Overall, unsupplemented heifers had greater mobilization of AA from myofibrillar protein, which provided N for urea synthesis and subsequent recycling. Supplemental RUP, when RDP was supplied, not only increased N retention but also supported increased urea N recycling and increased ruminal microbial protein synthesis.

Adaptations of hepatic amino acid uptake and net utilisation contributes to nitrogen economy or waste in lambs fed nitrogen- or energy-deficient diets.

PubMed

Kraft, G; Ortigues-Marty, I; Durand, D; Rémond, D; Jardé, T; Bequette, B; Savary-Auzeloux, I

2011-04-01

We investigated the effect of relative changes in dietary nitrogen (N) and energy supply and the subsequent variations in net portal appearance (NPA) of nitrogenous and energy nutrients on the net amino acid (AA) uptake by the liver and net N supply to the peripheral tissues. Six lambs were catheterised across the splanchnic tissues and received, in a replicated Latin square, one of three dietary treatments. The diets were formulated to either match the requirements of N and energy (C), or supply only 0.8 of the N requirement (LN) or 0.8 of the energy requirement (LE). Net fluxes of AA and urea-N were measured across the portal-drained viscera, and estimation of arterial hepatic flow allowed the estimation of hepatic fluxes. Catheters were implanted into the portal and hepatic veins as well as in the abdominal aorta for the measurement of AA fluxes. Animals fed the LN diet showed more efficient N retention (0.59 of digested N) than did the C and LE diet (0.50 and 0.33, respectively; P < 0.001). The NPA of total AA-N for the LN diet was only 0.60 of the value measured for the control (C) diet (P < 0.01). Despite this, the total estimated AA-N net splanchnic fluxes were not significantly different across the three diets (3.3, 1.9 and 2.6 g total AA-N/day for C, LN and LE, respectively, P = 0.52). Thus, different metabolic regulations must have taken place across the liver between the three experimental diets. A combination of decreased net uptake of total AA-N by the liver of animals in the LN diet (0.61 of the C diet; P = 0.002) and reduced urinary urea-N production (0.52 of the C diet; P = 0.001) spared AA from catabolism in the LN diet relative to the other two diets. For the LE diet, the urinary urea-N output was 1.3 times the value of the C diet (P = 0.01). This may relate to an increased catabolism of AA by the muscle and/or, to a lesser extent, to an increased utilisation of AA for gluconeogenesis in the liver. These effects may explain the reduced whole body protein retention observed with the LE diet.

[Acute urinary retention secondary to giant prolapsed ureterocele in a young adult woman. Case report].

PubMed

Villagómez-Camargo, Roberto; Chopin-Gazga, Marco; Saucedo-Bravo, Jonathan; García-Cano, Eugenio; Montiel-Jarquín, Álvaro

2016-01-01

Ureterocele is a cystic dilation of the distal ureteral segment. The incidence in women ranges from 1/5,000 to 1/12,000. In adults, they are poorly diagnosed and are asymptomatic. Prolapse through the urethra is uncommon, and involves acute urine retention and a reducible vulvar tumour. Woman of 24 years old, two previous caesarean and two abortions. She had incomplete bladder emptying, intermittent voiding, bladder straining and tenesmus, three months before admission. After the voiding effort she presented with acute urine retention with sudden onset of tumour in the vulva. The tumour was manually reduced under regional anaesthesia. A cystoscopy was performed, finding an ischaemic de-roofing of the anterior wall of the ureterocele, causing vesicoureteral reflux grade IV. Surgical correction was performed with Cohen re-implantation and insertion of a double-J catheter. The catheter was removed 30 days later, with a successful post-operative course. Its aetiology is unclear, and most are diagnosed by ultrasound in the prenatal period. The clinical presentation is variable, from urinary tract infection to prolapse. Despite its size, it may cause complications such as ischaemic de-roofing, which if diagnosed soon may be resolved successfully, as with this patient. The results and treatment may be favourable when no renal impact or concomitant anatomical changes are present, as is the case of this patient. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

A urethrorectal fistula due to prostatic abscess associated with urolithiasis in a dog.

PubMed

Agut, A; Lucas, X; Castro, A; De Membiela, F; Soler, M; Belda, E

2006-06-01

An 8-year-old, entire male crossbreed dog had a 2-day history of abdominal pain and straining to urinate and defecate. A diagnosis of urolithiasis with urinary retention, and probable prostatitis was made. The dog was treated with fluids and enrofloxacin. Five days later, ultrasonography of the prostate showed two hypoechoic areas compatible with abscesses. Twelve hours later, the patient started to urinate from the rectum during micturition and urethrorectal fistula was diagnosed. The omentalization of the prostatic abscesses and castration were performed and calculi were removed. The urethrorectal fistula was treated conservatively with an indwelling urinary catheter, a low residue diet and antibiotics. The dog recovered uneventfully without recurrence of the fistula.

Obstructive uropathy associated with myelomonocytic infiltration of the prostate.

PubMed

Hope-Gill, B; Goepel, J R; Collin, R C

1998-04-01

A 72 year old man was diagnosed with chronic myelomonocytic leukaemia (CMML) according to the FAB group classification. He presented with symptoms of anaemia, urinary frequency, hesitancy, and nocturia. He was later admitted with acute urinary retention and acute renal failure, which resolved with treatment. A transurethral resection of the prostate was performed. Histological examination showed fibromuscular hyperplasia with dense infiltration by myelomonocytes which stained positively with chloroacetate esterase; immunohistochemical staining was positive for lysozyme, CD43, CD45, and CD68. Following treatment with oral etoposide he transformed to acute myeloid leukaemia and eventually died. Myelomonocytic infiltration of the prostate has not been reported before. This case extends the spectrum of disease previously recognised in CMML.

Correlation of thermocouple data with voiding function after prostate cryoablation.

PubMed

Levy, David A

2010-02-01

To identify possible correlations of thermocouple recorded data with altered postoperative voiding function after prostate cryosurgery. A retrospective analysis of the records of 58 patients treated with prostate cryoablation from October 2005 through April 2009 was conducted. Multivariate analysis of patient age, presenting prostate-specific antigen level, Gleason score, clinical T stage, prostate volume, maximum low temperature thermocouple recordings, history of radiation and or hormonal therapy, were studied as possible correlative factors for altered postoperative voiding function. Of 58 patients, 22 (37.9%) manifested postcryoablation urgency and frequency (n = 13) requiring medical therapy or retention (n = 9). On multivariate analysis, age (P = .037) and an external sphincter temperature < or = 23 degrees C (P = .012) were associated with voiding frequency, urgency, or retention (odds ratio = 6.26, 95% CI: 1.62-24.16), whereas anterior rectal wall temperature (Denon) was weakly associated (P = .079). Thermocouple data provide an objective means of assessing cryosurgical outcomes. This is the first report of a correlation of such data to post-treatment voiding function. A total of 37.9% of patients experienced urgency and/or frequency or urinary retention after cryoablation of the prostate for localized disease. Older age and external sphincter temperature < or = 23 degrees C were statistically significant predictors of these events. The data suggest that limiting the degree of freezing at the external sphincter may decrease procedure related morbidity. Further study is warranted to better delineate temperature-related data on treatment outcomes. 2010 Elsevier Inc. All rights reserved.

Silver halide fiber optic radiometry for temperature monitoring and control of tissues heated by microwave

NASA Astrophysics Data System (ADS)

Shenfeld, Ofer; Belotserkovsky, Edward; Goldwasser, Benad; Zur, Albert; Katzir, Abraham

1993-02-01

The heating of tissue by microwave radiation has attained a place of importance in various medical fields, such as the treatment of malignancies, urinary retention, and hypothermia. Accurate temperature measurements in these treated tissues is important for treatment planning and for the control of the heating process. It is also important to be able to measure spacial temperature distribution in the tissues because they are heated in a nonuniform way by the microwave radiation. Conventional temperature sensors used today are inaccurate in the presence of microwave radiation and require contact with the heated tissue. Fiber optic radiometry makes it possible to measure temperatures accurately in the presence of microwave radiation and does not require contact with the tissue. Accurate temperature measurements of tissues heated by microwave was obtained using a silver halide optic radiometer, enabling control of the heating process in other regions of the tissue samples. Temperature mappings of the heated tissues were performed and the nonuniform temperature distributions in these tissues was demonstrated.

Trans-Obturator-Tape (T.O.T.) "outside-in" approach in surgical treatment of female stress urinary incontinence.

PubMed

Jovanović, M; Džamić, Z; Aćimović, M; Kajmaković, B; Pejčić, T

2014-01-01

The aim of the study was to analyzed the efficacy and safety of a minimally invasive surgical procedure using the Trans- Obturator-Tape with "outside-in" approach for treatment female stress urinary incontinence. 171 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (March 2010 to January 2014). 27 patients were previously operated for incontinence. Mean age was 59 years (37-80). 6 patients were having mixed incontinence, and 51 had SUI with urgencies. A non-elastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 22 months (4-45). At 12 months follow-up 91,2% of the patients were completely cured. The overall peri-operative complication rate was 6.4% with no vascular, nerve or bowel injury. 5 patients (2.9%) had post-operative urinary retention. The present study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence.

Usage of a Trans-Obturator-Tape (T.O.T.) "outside-in" approach in surgical treatment of female stress urinary incontinence.

PubMed

Jovanovic, Mirko; Vuksanović, Aleksandar; Dzamić', Zoran; Aćimović, Miodrag; Radovanović, Milan; Djurasić, Ljubomir

2011-01-01

The aim of the study was to analyzed the efficacy and safety of a new minimally invasive surgical procedure using the Trans-Obturator-Tape with"outside-in" approach for treatment female stress urinary incontinence. 31 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (March 2010 to January 2011). 5 patients were previously operated for incontinence. Mean age was 59 years (37-80). 10 patients were having mixed incontinence. A non-elastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 5 months (1-9). At 6 months follow-up 96.7% of the patients were completely cured. The overall peri-operative complication rate was 6.4% with no vascular, nerve or bowel injury. One patients (3.4%) had post-operative urinary retention. The present study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence.

Fuzzy cognitive map in differential diagnosis of alterations in urinary elimination: a nursing approach.

PubMed

Lopes, Maria Helena Baena de Moraes; Ortega, Neli Regina Siqueira; Silveira, Paulo Sérgio Panse; Massad, Eduardo; Higa, Rosângela; Marin, Heimar de Fátima

2013-03-01

To develop a decision support system to discriminate the diagnoses of alterations in urinary elimination, according to the nursing terminology of NANDA International (NANDA-I). A fuzzy cognitive map (FCM) was structured considering six possible diagnoses: stress urinary incontinence, reflex urinary incontinence, urge urinary incontinence, functional urinary incontinence, total urinary incontinence and urinary retention; and 39 signals associated with them. The model was implemented in Microsoft Visual C++(®) Edition 2005 and applied in 195 real cases. Its performance was evaluated through the agreement test, comparing its results with the diagnoses determined by three experts (nurses). The sensitivity and specificity of the model were calculated considering the expert's opinion as a gold standard. In order to compute the Kappa's values we considered two situations, since more than one diagnosis was possible: the overestimation of the accordance in which the case was considered as concordant when at least one diagnoses was equal; and the underestimation of the accordance, in which the case was considered as discordant when at least one diagnosis was different. The overestimation of the accordance showed an excellent agreement (kappa=0.92, p<0.0001); and the underestimation provided a moderate agreement (kappa=0.42, p<0.0001). In general the FCM model showed high sensitivity and specificity, of 0.95 and 0.92, respectively, but provided a low specificity value in determining the diagnosis of urge urinary incontinence (0.43) and a low sensitivity value to total urinary incontinence (0.42). The decision support system developed presented a good performance compared to other types of expert systems for differential diagnosis of alterations in urinary elimination. Since there are few similar studies in the literature, we are convinced of the importance of investing in this kind of modeling, both from the theoretical and from the health applied points of view. In spite of the good results, the FCM should be improved to identify the diagnoses of urge urinary incontinence and total urinary incontinence. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Fuzzy cognitive map in differential diagnosis of alterations in urinary elimination: A nursing approach

PubMed Central

de Moraes Lopes, Maria Helena Baena; Ortega, Neli Regina Siqueira; Silveira, Paulo Sérgio Panse; Massad, Eduardo; Higa, Rosângela; de Fátima Marin, Heimar

2013-01-01

Purpose To develop a decision support system to discriminate the diagnoses of alterations in urinary elimination, according to the nursing terminology of NANDA International (NANDA-I). Methods A fuzzy cognitive map (FCM) was structured considering six possible diagnoses: stress urinary incontinence, reflex urinary incontinence, urge urinary incontinence, functional urinary incontinence, total urinary incontinence and urinary retention; and 39 signals associated with them. The model was implemented in Microsoft Visual C++® Edition 2005 and applied in 195 real cases. Its performance was evaluated through the agreement test, comparing its results with the diagnoses determined by three experts (nurses). The sensitivity and specificity of the model were calculated considering the expert’s opinion as a gold standard. In order to compute the Kappa’s values we considered two situations, since more than one diagnosis was possible: the overestimation of the accordance in which the case was considered as concordant when at least one diagnoses was equal; and the underestimation of the accordance, in which the case was considered as discordant when at least one diagnosis was different. Results The overestimation of the accordance showed an excellent agreement (kappa = 0.92, p < 0.0001); and the underestimation provided a moderate agreement (kappa = 0.42, p < 0.0001). In general the FCM model showed high sensitivity and specificity, of 0.95 and 0.92, respectively, but provided a low specificity value in determining the diagnosis of urge urinary incontinence (0.43) and a low sensitivity value to total urinary incontinence (0.42). Conclusions The decision support system developed presented a good performance compared to other types of expert systems for differential diagnosis of alterations in urinary elimination. Since there are few similar studies in the literature, we are convinced of the importance of investing in this kind of modeling, both from the theoretical and from the health applied points of view. Limitations In spite of the good results, the FCM should be improved to identify the diagnoses of urge urinary incontinence and total urinary incontinence. PMID:22743142

Clinical course of a cohort of children with non-neurogenic daytime urinary incontinence symptoms followed at a tertiary center.

PubMed

Lebl, Adrienne; Fagundes, Simone Nascimento; Koch, Vera Hermina Kalika

2016-01-01

To characterize a cohort of children with non-neurogenic daytime urinary incontinence followed-up in a tertiary center. Retrospective analysis of 50 medical records of children who had attained bladder control or minimum age of 5 years, using a structured protocol that included lower urinary tract dysfunction symptoms, comorbidities, associated manifestations, physical examination, voiding diary, complementary tests, therapeutic options, and clinical outcome, in accordance with the 2006 and 2014 International Children's Continence Society standardizations. Female patients represented 86.0% of this sample. Mean age was 7.9 years and mean follow-up was 4.7 years. Urgency (56.0%), urgency incontinence (56.0%), urinary retention (8.0%), nocturnal enuresis (70.0%), urinary tract infections (62.0%), constipation (62.0%), and fecal incontinence (16.0%) were the most prevalent symptoms and comorbidities. Ultrasound examinations showed alterations in 53.0% of the cases; the urodynamic study showed alterations in 94.7%. At the last follow-up, 32.0% of patients persisted with urinary incontinence. When assessing the diagnostic methods, 85% concordance was observed between the predictive diagnosis of overactive bladder attained through medical history plus non-invasive exams and the diagnosis of detrusor overactivity achieved through the invasive urodynamic study. This subgroup of patients with clinical characteristics of an overactive bladder, with no history of urinary tract infection, and normal urinary tract ultrasound and uroflowmetry, could start treatment without invasive studies even at a tertiary center. Approximately one-third of the patients treated at the tertiary level remained refractory to treatment. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Nd:YAG laser incision of the vesical neck in obstructive BPH

NASA Astrophysics Data System (ADS)

Gilbert, Peter T. O.

2003-06-01

From February, 1995 through June, 2002, 68 patients underwent laser incision of the prostate at our clinic. By means of a 23 F cytoscope and a 600 micrometer lateral firing quartz fiber the vesical neck was incised at the 5 and 7 o'clock position at 60 W power. Total energy averaged 13648 J. Operative time did not exceed 15 minutes. General anesthesia was employed in all but one patient. 38 patients remained catheter-free whereas 30 patients were catheterized for two hours. Except for three cases, all patients were discharged on the same day, usually after the first micturition. Anti-inflammatory treatment was administered for two weeks, Cotrimoxazole for 5 days. No serious complications were encountered. Minor side effects included urinary retention (1 pat.), urinary infection (3 pat.) and retrograde ejaculation (1 pat.). Considering a mean follow-up of 21 months, the average Qmax improved enormously (25.4 ml/s versus 10.9 ml/s), as did residual urine volume (35 ml versus 95 ml) and IPSS (7.1 versus 20.5). Three patients required TUR-P 2-3 years after laser surgery and one patient underwent radical retropubic prostatectomy for prostate cancer 2 years later. In conclusion, Nd:YAG laser incision of the prostate is a simple, safe, reliable and cost-effective outpatient procedure.

20 CFR 655.167 - Document retention requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Document retention requirements. 655.167... retention requirements. (a) Entities required to retain documents. All employers filing an Application for... retain the documents and records proving compliance with this subpart. (b) Period of required retention...

Adaptogenic and nootropic activities of aqueous extract of Vitis vinifera (grape seed): an experimental study in rat model

PubMed Central

Sreemantula, Satyanarayana; Nammi, Srinivas; Kolanukonda, Rajabhanu; Koppula, Sushruta; Boini, Krishna M

2005-01-01

Background The aerial parts of Vitis vinifera (common grape or European grape) have been widely used in Ayurveda to treat a variety of common and stress related disorders. In the present investigation, the seed extract of V. vinifera was evaluated for antistress activity in normal and stress induced rats. Furthermore, the extract was studied for nootropic activity in rats and in-vitro antioxidant potential to correlate its antistress activity. Methods For the evaluation of antistress activity, groups of rats (n = 6) were subjected to forced swim stress one hour after daily treatment of V. vinifera extract. Urinary vanillylmandelic acid (VMA) and ascorbic acid were selected as non-invasive biomarkers to assess the antistress activity. The 24 h urinary excretion of vanillylmandelic acid (VMA) and ascorbic acid were determined by spectrophotometric methods in all groups under normal and stressed conditions. The nootropic activity of the extract as determined from acquisition, retention and retrieval in rats was studied by conditioned avoidance response using Cook's pole climbing apparatus. The in vitro antioxidant activity was determined based on the ability of V. vinifera to scavenge hydroxyl radicals. Results Daily administration of V. vinifera at doses of 100, 200 and 300 mg/kg body weight one hour prior to induction of stress inhibited the stress induced urinary biochemical changes in a dose dependent manner. However, no change in the urinary excretion of VMA and ascorbic acid was observed in normal animals at all the doses studied. The cognition, as determined by the acquisition, retention and recovery in rats was observed to be dose dependent. The extract also produced significant inhibition of hydroxyl radicals in comparison to ascorbic acid in a dose dependent manner. Conclusion The present study provides scientific support for the antistress (adaptogenic), antioxidant and nootropic activities of V. vinifera seed extract and substantiate the traditional claims for the usage of grape fruits and seeds in stress induced disorders. PMID:15656916

Development and validation of an algorithm for identifying urinary retention in a cohort of patients with epilepsy in a large US administrative claims database.

PubMed

Quinlan, Scott C; Cheng, Wendy Y; Ishihara, Lianna; Irizarry, Michael C; Holick, Crystal N; Duh, Mei Sheng

2016-04-01

The aim of this study was to develop and validate an insurance claims-based algorithm for identifying urinary retention (UR) in epilepsy patients receiving antiepileptic drugs to facilitate safety monitoring. Data from the HealthCore Integrated Research Database(SM) in 2008-2011 (retrospective) and 2012-2013 (prospective) were used to identify epilepsy patients with UR. During the retrospective phase, three algorithms identified potential UR: (i) UR diagnosis code with a catheterization procedure code; (ii) UR diagnosis code alone; or (iii) diagnosis with UR-related symptoms. Medical records for 50 randomly selected patients satisfying ≥1 algorithm were reviewed by urologists to ascertain UR status. Positive predictive value (PPV) and 95% confidence intervals (CI) were calculated for the three component algorithms and the overall algorithm (defined as satisfying ≥1 component algorithms). Algorithms were refined using urologist review notes. In the prospective phase, the UR algorithm was refined using medical records for an additional 150 cases. In the retrospective phase, the PPV of the overall algorithm was 72.0% (95%CI: 57.5-83.8%). Algorithm 3 performed poorly and was dropped. Algorithm 1 was unchanged; urinary incontinence and cystitis were added as exclusionary diagnoses to Algorithm 2. The PPV for the modified overall algorithm was 89.2% (74.6-97.0%). In the prospective phase, the PPV for the modified overall algorithm was 76.0% (68.4-82.6%). Upon adding overactive bladder, nocturia and urinary frequency as exclusionary diagnoses, the PPV for the final overall algorithm was 81.9% (73.7-88.4%). The current UR algorithm yielded a PPV > 80% and could be used for more accurate identification of UR among epilepsy patients in a large claims database. Copyright © 2016 John Wiley & Sons, Ltd.

Resistance training reduces whole-body protein turnover and improves net protein retention in untrained young males.

PubMed

Hartman, Joseph W; Moore, Daniel R; Phillips, Stuart M

2006-10-01

It is thought that resistance exercise results in an increased need for dietary protein; however, data also exists to support the opposite conclusion. The purpose of this study was to determine the impact of resistance exercise training on protein metabolism in novices with the hypothesis that resistance training would reduce protein turnover and improve whole-body protein retention. Healthy males (n = 8, 22 +/- 1 y, BMI = 25.3 +/- 1.8 kg.m(-2)) participated in a progressive whole-body split routine resistance-training program 5d/week for 12 weeks. Before (PRE) and after (POST) the training, oral [15N]-glycine ingestion was used to assess nitrogen flux (Q), protein synthesis (PS), protein breakdown (PB), and net protein balance (NPB = PS-PB). Macronutrient intake was controlled over a 5d period PRE and POST, while estimates of protein turnover and urinary nitrogen balance (N(bal) = N(in) - urine N(out)) were conducted. Bench press and leg press increased 40% and 50%, respectively (p < 0.01). Fat- and bone-free mass (i.e., lean muscle mass) increased from PRE to POST (2.5 +/- 0.8 kg, p < 0.05). Significant PRE to POST decreases (p <0.05) occurred in Q (0.9 +/- 0.1 vs. 0.6 +/- 0.1 g N.kg(-1).d(-1)), PS (4.6 +/- 0.7 vs. 2.9 +/- 0.3 g.kg(-1).d(-1)), and PB (4.3 +/- 0.7 vs. 2.4 +/- 0.2 g.kg(-1).d(-1)). Significant training-induced increases in both NPB (PRE = 0.22 +/- 0.13 g.kg(-1).d(-1); POST = 0.54 +/- 0.08 g.kg(-1).d(-1)) and urinary nitrogen balance (PRE = 2.8 +/- 1.7 g N.d(-1); POST = 6.5 +/- 0.9 g N.d(-1)) were observed. A program of resistance training that induced significant muscle hypertrophy resulted in reductions of both whole-body PS and PB, but an improved NPB, which favoured the accretion of skeletal muscle protein. Urinary nitrogen balance increased after training. The reduction in PS and PB and a higher NPB in combination with an increased nitrogen balance after training suggest that dietary requirements for protein in novice resistance-trained athletes are not higher, but lower, after resistance training.

[Photoselective vaporization of the prostate in severe heart disease or dementia patients who are not candidates for TUR-P].

PubMed

Kuwahara, Yoshitaka; Otsuki, Hideo; Nagakubo, Ichiro; Horiba, Masaki

2008-09-01

TUR-P for the treatment of BPH is not performed in cases with severe heart disease due to the risk of bleeding and hyponatremia etc. Besides, in cases with severe central nerve disease and dementia, TUR-P is not performed because patients cannot take postoperative rest. We report the efficacy and the safety of Photoselective Vaporization of the Prostate (PVP) using a high-power 80 W KTP (potassiumu-titayl-phosphate) in patients for whom TUR-P cannot be performed. 312 patients underwent PVP in our hospital. Of these 312 patients, 8 patients with severe heart disease (American Society of Anesthesiology score of 3 or greater) and 4 patients with severe dementia (Performance status of 3 or greater) were evaluated. We assessed peak flow rate and post-void residual urine volume preoperatively and at 3 months postoperatively, safety of the procedure, and complication rates. The mean age was 81 years old (range 67 to 94) and the mean prostate volume was 63.8 ml (range 19 to 120). Urethral catheter was used in 8 patients because of chronic urinary retention. PVP was performed with GreenLightPV and a saline solution was used for irrigation. Upon completion of the procedure an 18Fr Foley catheter was inserted without continuous bladder irrigation and removed next morning, as a rule. In all 12 patients, PVP was performed successfully without any intraoperative complications. Mean operating time was 101 minutes (range 28 to 184), mean total laser energy was 336,853 J (range 74,396 to 550,000), and mean irrigation volume was 21 L (range 8 to 36). The hemoglobin value changed from mean 13.1 mg/dl preoperatively to 12.2 mg/dl postoperatively. Blood transfusions were not required and hyponatremia was not observed. In 1 case, the urethral catheter was removed 3 hours following surgery. In the other cases, the urethral catheter was removed next morning. All patients could urinate after catheter removal and were discharged on the day following operation. Mean peak flow rate increased to 18 ml/s and mean post-void residual urine decreased to 46.9 ml at 3 months. No postoperative complications (urinary retention, hematuria, urinary tract infection, etc.) were observed. PVP is safe and effective in high-risk patients who are not candidates for TUR-P.

Evaluation of meat meal, chicken meal, and corn gluten meal as dietary sources of protein in dry cat food

PubMed Central

2005-01-01

Abstract The nutritional value of meat meal (MM), chicken meal (CM), and corn gluten meal (CGM) as dietary sources of protein in dry food formulated for adult cats was evaluated. Twelve healthy adult cats (11 males and 1 female) were used. Dry diets containing MM, CM, or CGM as the main protein source were given for a 3-week period in a 3 × 3 Latin-square design. Digestion and balance experiments were conducted during the last 7 d of each period. In addition, freshly voided urine was taken to determine urinary pH and number of struvite crystals. As compared with the CM diet, dry-matter digestibility was higher and lower for the MM and CGM groups, respectively. Percentages of nitrogen (N) absorption and N retention to N intake were higher in the MM group, and N utilization was not different between the CM group and the CGM group. All cats excreted alkaline urine (pH > 7). Urinary pH, struvite activity product, and number of struvite crystals in urine were lower for the CGM group. There was no difference in retention of calcium and magnesium among the groups. From the point of view of digestibility and N utilization, MM is superior to CGM, and CM is better than or equivalent to CGM as a protein source of dry foods for adult cats. However, when CM is used as a dietary protein source, some manipulation of dietary base excess may be needed to control urinary acid-base balance, because CM contains higher calcium and phosphorus. PMID:16479729

Adhesion of thiolated silica nanoparticles to urinary bladder mucosa: Effects of PEGylation, thiol content and particle size.

PubMed

Mun, Ellina A; Williams, Adrian C; Khutoryanskiy, Vitaliy V

2016-10-15

Intravesical drug administration is used to deliver cytotoxic agents through a catheter to treat bladder cancer. One major limitation of this approach is poor retention of the drug in the bladder due to periodic urine voiding. Mucoadhesive dosage forms thus offer significant potential to improve drug retention in the bladder. Here, we investigate thiolated silica nanoparticles retention on porcine bladder mucosa in vitro, quantified through Wash Out50 (WO50) values, defined as the volume of liquid necessary to remove 50% of the adhered particles from a mucosal tissue. Following irrigation with artificial urine solution, the thiolated nanoparticles demonstrate significantly greater retention (WO50 up to 36mL) compared to non-mucoadhesive dextran (WO50 7mL), but have weaker mucoadhesive properties than chitosan (WO50 89mL). PEGylation of thiolated silica reduces their mucoadhesion with WO50 values of 29 and 8mL for particles decorated with 750 and 5000Da PEG, respectively. The retention of thiolated silica nanoparticles is dependent on their thiol group contents and physical dimensions. Copyright © 2016 Elsevier B.V. All rights reserved.

Objective and subjective cure rates after trans-obturator tape (OBTAPE) treatment of female urinary incontinence.

PubMed

Deval, Bruno; Ferchaux, Jérome; Berry, Richard; Gambino, Sandro; Ciofu, Calin; Rafii, Arash; Haab, François

2006-02-01

To evaluate the safety and efficacy of a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure (OBTAPE), Mentor-Porges, Le Plessis Robinson, France) for women with stress urinary incontinence. Between January 2003 and January 2005, 129 consecutive women (mean age 57.2 years) underwent OBTAPE) in two academic centers. All the patients had stress urinary incontinence preoperatively. Detrusor instability was ruled out by cystometry. The women were evaluated 1, 6 and 12 months postoperatively. The objective cure rate was evaluated by clinical examination and the subjective cure rate was assessed using the KHQ and BFLUTS questionnaire. Mean follow-up was 17.2+/-4.7 months (range 4 to 28 months). The objective and subjective cure rates were respectively 89.9% and 77.5%. Most of the patients received general anesthesia (85.3%). Urinary retention was observed in two women (1.5%), necessitating tape adjustment. Voiding difficulties were observed in 7 cases (5.4%) necessitating intermittent self-catheterization for 4.2+/-2.4 days (range 1 to 7 days). Seven patients developed vaginal erosion (one with vaginal extrusion, and two with an obturator abscess). Complete mesh removal was necessary in 6 patients, four of whom had recurrent stress urinary incontinence. Our results suggest that the OBTAPE) is an effective treatment for women with stress urinary incontinence. However, vaginal mesh erosion occurred in 6.2% of women, and this implies the need for careful follow-up.

Predictors of Calcium Retention in Adolescent Boys

PubMed Central

Hill, Kathleen M.; Braun, Michelle; Kern, Mark; Martin, Berdine R.; Navalta, James W.; Sedlock, Darlene A.; McCabe, Linda; McCabe, George P.; Peacock, Munro; Weaver, Connie M.

2008-01-01

Context: The relationship between calcium (Ca) intake and Ca retention in adolescent boys was recently reported. Objective: This study evaluated the influence of Ca intake, serum hormone levels, biomarkers of bone metabolism, habitual physical activity, habitual Ca intake, and physical fitness on Ca retention in the same sample. Design: This study was a randomized, cross-over design that consisted of two 3-wk metabolic balance periods. Setting: The study took place on a university campus as a summer camp. Patients or Other Participants: A total of 31 American white boys (13–15 yr) participated in the study. Interventions: Each subject consumed a controlled diet with one of five high-low Ca intake pairs that ranged from 670-2003 mg/d, which was manipulated utilizing a fortified beverage. Main Outcome Measures: Ca retention was determined by Ca intake minus urinary and fecal Ca excretion during each balance period. Results: Ca intake explained 21.7% of the variability in Ca retention, and serum IGF-I concentration explained an additional 11.5%. Other serum hormone levels did not significantly add to the model. Biomarkers of bone metabolism, habitual physical activity, habitual Ca intake, and physical fitness were not significant predictors of Ca retention in adolescent boys. Conclusions: IGF-I, a regulator of growth during puberty, is an important predictor of Ca retention in adolescent boys. However, dietary Ca intake is an even greater predictor of Ca retention during this period of growth. PMID:18840643

Urethral obstruction after anti-incontinence surgery in women: evaluation, methodology, and surgical results.

PubMed

Austin, P; Spyropoulos, E; Lotenfoe, R; Helal, M; Hoffman, M; Lockhart, J L

1996-06-01

To evaluate a group of women with voiding dysfunction and a low maximum flow rate (MFR) (less than or equal to 12 mL/s) after surgery for stress urinary incontinence (SUI); to establish diagnostic parameters indicating obstruction in an attempt to determine treatment selection; and to evaluate preliminary surgical results. Eighteen women who underwent anti-incontinence surgery for SUI were diagnosed as having infravesical obstruction (IO). Thirteen women (group A [72%]) presented with clinically predominant symptoms of urgency, frequency, intermittency, and a variable vesical residual volume (RV), and five (group B [28%]) had as their most significant symptoms a high vesical RV and urinary tract infection that had been managed with intermittent catheterization (IC). The diagnosis of IO, suspected after clinical history, was established after physical examination and cystoscopic, cystographic and urodynamic investigations. Bladder instability was demonstrated in 6 group A patients (46%) and 1 group B patient (20%) (P = NS). Mean MFRs were 8.07 and 7.2 mL/s, respectively, in both groups (P = NS). Mean maximal voiding pressures (MVPs) were 20.23 and 5 cm H20, and mean RVs were 57.46 and 174 mL, respectively; both differences were statistically very significant (P <0.01 and P <0.001, respectively). High to normal MVPs occurred in 2 patients overall (11%). Bladder neck overcorrection, midurethral distortion, and postsurgical cystocele were demonstrated in both groups in 11 (85%), 0, and 2 (15%) patients in group A and 3 (60%), 2 (40%), and 3 (60%) patients in group B, respectively (P = NS). Patients in group A were treated surgically with cystourethrolysis and a repeated, less obstructive anti-incontinence operation. In group B 2 women (40%) had a similar surgical procedure; 1 (20%) underwent isolated urethrolysis; and 2 (40%) are currently maintained with IC. Among these 18 patients with voiding dysfunction after anti-incontinence surgery, a primary diagnosis of IO was established clinically. Only patients with a low MFR were selected for this study. Cytographic and endoscopic investigation as well as the presence of postsurgical cystocele assisted in establishing the diagnosis. The success rate with urethrolysis and resuspension was 60% for the 13 women with predominantly urgency, frequency, and the highest MVPs (20.23 +/- 9.67 cm H20 [group A) and 33% for the 5 women with urinary retention presenting the lowest MVPs (5.00 +/- 7.07 cm H20 [group A]) and 33% for the 5 women with urinary retention presenting the lowest MVPs (5.00 +/- 7.07 cm H20 [group B]). An added resuspension procedure is probably unnecessary in the latter group of patients and requires careful individual selection in the former group.

Behavior of Americium in Simulated Wounds in Nonhuman Primates

DOE PAGES

Poudel, Deepesh; Guilmette, Raymond A.; Bertelli, Luiz; ...

2017-06-01

An americium solution injected intramuscularly into several nonhuman primates (NHPs) was found to behave differently than predicted by the wound models described in the NCRP Report 156. This was because the injection was made along with a citrate solution, which is known to be more soluble than chlorides, oxides, or nitrates on which the NCRP Report was based. We developed a multi-exponential wound model specific to the injected americium solution based on the retention in the intramuscular sites. The model was coupled with the americium systemic model to interpret the urinary excretion data and assess the intake, and it wasmore » determined that the models were adequate to predict early urinary excretion in most cases but unable to predict late urinary excretion. This was attributed to the differences in the systemic handling of americium between humans and nonhuman primates. Furthermore, information on the type of wounds, solubility, particle size, mass, chemical form, etc., should always be considered when performing wound dosimetry.« less

Ileal loop ureteroileostomy in patients with neurogenic bladder. Personal experience with 54 patients.

PubMed

Kambouris, A A; Allaben, R D; Carpenter, W S; Shumaker, E J

1976-02-01

(1) In a six year experience with ileal loops in patients with neurogenic bladder, 49% of the patients were paralyzed, 30% had multiple sclerosis, and 91% had recurrent or persistent urinary tract infection. Reflux, incontinence, retention, and bladder calculi were additional indications for supravesical urinary diversions. (2) All loops were performed in a similar manner, most of them placed retroperitoneally, and a vigorous program of postoperative care was followed. There were no postoperative deaths, and a moderate number of complications occurred in 51.8% of the patients. (3) The participation of the enterostomal therapist is the preparation of the patient and in the immediate and long-term stomal care has been invaluable and is strongly recommended.

Branched chains support postoperative protein synthesis.

PubMed

Cerra, F B; Upson, D; Angelico, R; Wiles, C; Lyons, J; Faulkenbach, L; Paysinger, J

1982-08-01

A blinded, prospective trial of the effects of branched-chain amino acid (BcAA)-enriched total parenteral nutrition (TPN) versus standard TPN was undertaken in nonseptic noncirrhotic abdominal surgery patients and patients with multiple traumatic injuries. The study reflected data from the immediate 7-day postoperative period. With isocaloric and isonitrogenous input, the BcAA-TPN patients achieved positive nitrogen balance on day 3. Although the urinary nitrogen output was decreased by day 3 in BcAA-TPN, the plasma BcAA levels did not increase until day 6. With no change in 3-methylhistidine urinary excretion, the early nitrogen retention with BcAA-TPN probably reflects a stimulation of protein synthesis. The ability to favorably modulate the metabolic stress response with alternate fuels has become a clinical reality.

Risk factors for reinsertion of urinary catheter after early removal in thoracic surgical patients.

PubMed

Young, John; Geraci, Travis; Milman, Steven; Maslow, Andrew; Jones, Richard N; Ng, Thomas

2018-03-08

To reduce the incidence of urinary tract infection, Surgical Care Improvement Project 9 mandates the removal of urinary catheters within 48 hours postoperatively. In patients with thoracic epidural anesthesia, we sought to determine the rate of catheter reinsertion, the complications of reinsertion, and the factors associated with reinsertion. We conducted a prospective observational study of consecutive patients undergoing major pulmonary or esophageal resection with thoracic epidural analgesia over a 2-year period. As per Surgical Care Improvement Project 9, all urinary catheters were removed within 48 hours postoperatively. Excluded were patients with chronic indwelling catheter, patients with urostomy, and patients requiring continued strict urine output monitoring. Multivariable logistic regression analysis was used to identify independent risk factors for urinary catheter reinsertion. Thirteen patients met exclusion criteria. Of the 275 patients evaluated, 60 (21.8%) required reinsertion of urinary catheter. There was no difference in the urinary tract infection rate between patients requiring reinsertion (1/60 [1.7%]) versus patients not requiring reinsertion (1/215 [0.5%], P = .389). Urethral trauma during reinsertion was seen in 1 of 60 patients (1.7%). After reinsertion, discharge with urinary catheter was required in 4 of 60 patients (6.7%). Multivariable logistic regression analysis found esophagectomy, lower body mass index, and benign prostatic hypertrophy to be independent risk factors associated with catheter reinsertion after early removal in the presence of thoracic epidural analgesia. When applying Surgical Care Improvement Project 9 to patients undergoing thoracic procedures with thoracic epidural analgesia, consideration to delayed removal of urinary catheter may be warranted in patients with multiple risk factors for reinsertion. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

[Epidemiology of emergency consultations for acute urine retention].

PubMed

Gas, J; Liaigre-Ramos, A; Beauval, J B; Roumiguié, M; Tostivint, V; Patard, P-M; Huyghe, E; Soulié, M; Charpentier, S; Gamé, X

2018-02-01

Acute urinary retention (AUR) is a common reason for emergency consultation. It may be spontaneous or precipitated and affects both men and women. The purpose of this study was to determine the profile of men visiting emergency departments for an AUR. A retrospective monocentric study including all men who consulted the emergency department between January 2014 and December 2016 for AUR was conducted. In 3 years, 731 patients were admitted for AUR (611 men and 120 women). The mean age was 71.6±14 years with a mean retention volume of 948±668mL drained for 96% of patients (n=584) through a bladder catheter and 4% (n=27) with a suprapubic catheter. Most patients had an urological (66%, n=104) or neurologic (40%, n=242) history and 23% (n=136) already had an episode of AUR. In 28% of cases (n=173), the globe was not painful. A majority of AUR were spontaneous, 53% (n=326) versus 46% (n=279) who were precipitated, secondary to a recent surgical procedure (<1 month) (15%, n=89), hematuria (9%, n=54), or male urinary tract infections (7%, n=42). Patients were treated externally in 71% (n=436), 25% (n=153) were hospitalized with significantly more comorbidities. Men consulting emergency for AUR are 72 years old, with a globe volume of 942mL. Thirty-three percent have a history of BPH, with a prostate treatment like alpha-blockers type. Almost all patients were treated with a bladder catheter and the majority was treated externally. 4. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Use and risks of surgical mesh for pelvic organ prolapse surgery in women in New York state: population based cohort study.

PubMed

Chughtai, Bilal; Mao, Jialin; Buck, Jessica; Kaplan, Steven; Sedrakyan, Art

2015-06-02

To assess the use of mesh in pelvic organ prolapse surgery, and compare short term outcomes between procedures using and not using mesh. All inclusive, population based cohort study. Statewide surgical care captured in the New York Statewide Planning and Research Cooperative System. Women who underwent prolapse repair procedures in New York state from 2008 to 2011. 90 day safety events and reinterventions within one year, after propensity score matching. Categorical, time to event, and subgroup analyses (<65 and ≥ 65 year age groups) were conducted. Of 27,991 patients in total, 7338 and 20, 653 underwent prolapse repair procedures with and without mesh, respectively. Mesh use increased by 44.7%, from 1461 procedures in 2008 to 2114 procedures in 2011. Most patients in the cohort were younger than 65 years (62.3% (n=17,424/27, 991)). However, more patients were aged 65 years and older in the mesh group than in the non-mesh group (44.3% (n=3249) v 35.4% (n=7318)). Complications after surgery were not common, irrespective of the use or non-use of mesh. After propensity score matching, patients who received the surgery with mesh had a higher chance of having a reintervention within one year (mesh 3.3% v no mesh 2.2%, hazard ratio 1.47 (95% confidence interval 1.21 to 1.79)) and were more likely to have urinary retention within 90 days (mesh 7.5% v no mesh 5.6%, risk ratio 1.33 (95% confidence interval 1.18 to 1.51)), compared with those who received surgery without mesh. In subgroup analyses based on age, mesh use was associated with an increased risk of reintervention within one year in patients under age 65 years, and increased risk of urinary retention in patients aged 65 years and over. Despite multiple warnings released by the US Food and Drug Administration since 2008, use of mesh in pelvic organ prolapse surgery continues to grow. In this statewide comprehensive study, mesh procedures were associated with an increased risk of reinterventions within one year and urinary retention after surgery. © Chughtai et al 2015.

Predictors of early postoperative voiding dysfunction and other complications following a midurethral sling.

PubMed

Ripperda, Christopher M; Kowalski, Joseph T; Chaudhry, Zaid Q; Mahal, Aman S; Lanzer, Jennifer; Noor, Nabila; Good, Meadow M; Hynan, Linda S; Jeppson, Peter C; Rahn, David D

2016-11-01

The rates reported for postoperative urinary retention following midurethral sling procedures are highly variable. Determining which patients have a higher likelihood of failing a voiding trial will help with preoperative counseling prior to a midurethral sling. The objective of the study was to identify preoperative predictors for failed voiding trial following an isolated midurethral sling. A retrospective, multicenter, case-control study was performed by including all isolated midurethral sling procedures performed between Jan. 1, 2010 to June 30, 2015, at 6 academic centers. We collected demographics, medical and surgical histories, voiding symptoms, urodynamic evaluation, and intraoperative data from the medical record. We excluded patients not eligible for attempted voiding trial after surgery (eg, bladder perforation requiring catheterization). Cases failed a postoperative voiding trial and were discharged with an indwelling catheter or taught intermittent self-catheterization; controls passed a voiding trial. We also recorded any adverse events such as urinary tract infection or voiding dysfunction up to 6 weeks after surgery. Bivariate analyses were completed using Mann-Whitney and Pearson χ 2 tests as appropriate. Multivariable stepwise logistic regression was used to determine predictors of failing a voiding trial. A total of 464 patients had an isolated sling (70.9% retropubic, 28.4% transobturator, 0.6% single incision); 101 (21.8%) failed the initial voiding trial. At follow-up visits, 90.4% passed a second voiding trial, and 38.5% of the remainder passed on the third attempt. For the bivariate analyses, prior prolapse or incontinence surgery was similar in cases vs controls (31% vs 28%, P = .610) as were age, race, body mass index, and operative time. Significantly more of the cases (32%) than controls (22%) had a Charlson comorbidity index score of 1 or greater (P = .039). Overactive bladder symptoms of urgency, frequency, and urgency incontinence were similar in both groups as was detrusor overactivity in those with a urodynamic evaluation (29% vs 22%, P = .136), but nocturia was reported more in the cases (50% vs 38%, P = .046). Mean (SD) bladder capacity was similar in both groups (406 [148] mL vs 388 [122] mL, P = .542) as was maximum flow rate with uroflowmetry and pressure flow studies. Cases were significantly more likely to have a voiding type other than detrusor contraction: 37% vs 25%, P = .027, odds ratio, 1.79 (95% confidence interval, 1.07-3.00). There was no difference in voiding trial failures between retropubic and transobturator routes (23.1% vs 18.9%, P = .329). Within 6 weeks of surgery, the frequency of urinary tract infection in cases was greater than controls (20% vs 6%, P < .001; odds ratio, 3.51 [95% confidence interval, 1.82-6.75]). After passing a repeat voiding trial, cases were more likely to present with acute urinary retention (10% vs 3%, P = .003; odds ratio, 4.00 [95% confidence interval, 1.61-9.92]). For multivariable analyses, increasing Charlson comorbidity index increased the risk of a voiding trial failure; apart from this, we did not identify other demographic information among the patients who did not undergo urodynamic evaluation that reliably forecasted a voiding trial failure. The majority of women will pass a voiding trial on the first attempt after an isolated midurethral sling. Current medical comorbidities are predictive of a voiding trial failure, whereas other demographic/examination findings are not. Patients failing the initial voiding trial are at an increased risk of postoperative urinary tract infection or developing acute retention after passing a subsequent voiding trial. Copyright © 2016 Elsevier Inc. All rights reserved.

Management of urinary tract infections: historical perspective and current strategies: Part 1--Before antibiotics.

PubMed

Nickel, J Curtis

2005-01-01

Urinary tract infections (UTIs) have plagued mankind long before bacteria were recognized as the causative agents of disease and before urology became an established medical specialty. To our knowledge a comprehensive review of the recorded medical history of UTI from its first description in ancient Egyptian papyri through today has not been attempted until now. Numerous resources were used to collect the information described in this review. Older textbooks from the school of medicine library at our institution were used to collect information on UTI in ancient times. Medical texts from the 19th century contains information regarding the treatment of UTI during that era. Early volumes of the Journal of Urology from the beginning of the 20th century are rich with information on the first attempts at chemotherapy for UTI. MEDLINE searches were used to collect appropriate information after 1969. The Ebers papyrus from ancient Egypt recommended herbal treatments to ameliorate urinary symptoms without providing insight into pathological mechanisms. Hippocrates believed that disease was caused by disharmony of the 4 humors and accordingly diagnosed urinary disorders. Roman medicine further expanded the conservative approach (bed rest, diet, narcotics and herbs) advocated by Greek physicians, while also improving invasive techniques (surgical lithotomy for stones and catheterization for retention). The Arabian physician Aetius refined uroscopy and created a detailed classification and interpretation of urinary disease based on this technique. During the Middle Ages no major advances occurred, although existing therapies were refined and treatments for gonococcal urethritis were well described. The early 19th century provided vivid and detailed descriptions of UTIs without the knowledge that they were caused by microorganisms. Management included hospitalization, bed rest, attention to diet, plasters, narcotics, herbal enemas and douches, judicious bleeding (direct bleeding, cupping and leeches), and surgery for stones, abscess and retention. The discovery of microorganisms as the etiological agents of infectious diseases in general and inflammation associated with urinary diseases in particular provided an impetus for physicians critically to examine management approaches and develop evidence based strategies for UTI treatment. Various antibacterial agents, such as hexamine, mercurochrome and others (hexylresorcinol, methylene blue, pyridium, acriflavin and mandelic acid), showed promise in laboratory studies but their efficacy in clinical investigations was disappointing. Treatments for UTI until the discovery of antibiotics were largely palliative because the bacterial origin of UTI was not recognized and no specific antimicrobial therapies were available.

[Laparoscopic approach for artificial urinary sphincter implantation in women with severe urinary stress incontinence].

PubMed

Trolliet, S; Mandron, E; Lang, H; Jacqmin, D; Saussine, C

2013-09-01

To evaluate, feasibility, efficacy and morbidity of laparoscopic artificial urinary sphincter (AUS) implantation in women with severe stress urinary incontinence. Twenty-six women with severe stress urinary incontinence were treated between October 2007 and January 2012 by laparoscopic implantation of an AUS AMS 800 (American medical Systems, Inc., Minnetonka, Minnesota). For 18 patients AUS was primary implanted and, for eight, AUS was revised for a mechanical failure. Three patients had a concomitant laparoscopic vaginal prolapse repair. Mean value was for age 64 years, BMI 27.8kg/m2, and mean maximal urethral closure pressure was 26.75cm of water. Most of the patients (88%) had a history of pelvic or incontinence surgery. The study was a retrospective analysis of operative parameters, complications and functional results. Three conversions in open surgery and five bladder injuries were described. Mean operative time was 149 minutes. Bladder catheter was removed at a mean of day 3.8. Mean post-operative stay was 5 days. Early postoperative complications consist in eight acute transient urinary retentions, two pump migrations, and one vaginal injury. Late post-operative complications consist in one vaginal erosion. Explantation of AUS was performed for these last two patients. Mean follow-up was 20 months. Sixteen patients are totally continent, five have a social continence (1 pad/day) and three need more than one pad/day. Our results compare favorably to literature either for laparoscopic or conventional approach with a limited learning curve. Laparoscopic implantation of AUS in women with severe stress urinary incontinence was feasible and efficient. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Can low urinary tract symptoms influence postprostatectomy urinary incontinence?

PubMed

Tienza, Antonio; Hevia, Mateo; Merino, Imanol; Diez-Caballero, Fernando; Rosell, David; Pascual, Juan I; Zudaire, Juan J; Robles, José E

2016-08-01

The aim of this study was to analyze what kind of urinary symptoms patients have before receiving treatment by radical prostatectomy (RP), and to evaluate their influence on urinary incontinence (UI). Between 2002 and 2012, 758 consecutive patients underwent RP for clinically localized prostate cancer (PCa). Surgery was carried out by open retropubic RP in 545 (73.1%) of patients and laparoscopic RP in 201 (27%) by 5 surgeons who were excluded from data collection and analysis. The following symptoms were collected from the last urological check-ups or pre-operative consultation and classified as: storage symptoms, voiding symptoms, post micturition symptoms, history of acute urinary retention, benign prostatic hyperplasia treatment, history of transurethral resection of the prostate (TURP). A total of 661 patients were included on analysis: 136 (20.6%) patients reported low urinary tract symptoms (LUTS), 162 (24.5%) were considered incontinent after RP, and 45 (33.1%) of them reported LUTS before surgery. Postprostatectomy urinary incontinence (PPUI) was significantly different in patients with LUTS (117 [22.3%] vs. 45 [33.1%], P=0.009). The presence of any LUTS influence significantly in the appearance of PPUI (OR=1.72 [95% CI: 1.14-2.6), P=0.01). TURP is independently influential in PPUI (OR=6.13 [95% CI: 1.86-20.18], P=0.003). A patient with LUTS before surgery has an increased risk of 70% or even 200% to suffer PPUI and a patient who received treatment by TURP is 6 times at higher risk of PPUI. In conclusion, patients with LUTS are likely to present PPUI. History of TURP is influential by itself over PPUI. A good preoperative consultation is important to assess continence status and to create realistic expectations to patients before RP.

[TVT and TOT for surgical correction of female stress urinary incontinence. Comparison between techniques].

PubMed

Torres Zambrano, G; Lujan Galán, M; Martín García, C; García Tello, A; Rodríguez García, N; Berenguer Sánchez, A

2008-10-01

Retrospective analysis of a series of patients with stress urinary incontinence that underwent surgery in our department, by means of the TVT and TOT techniques. We evaluate post operative continence, considering "cured" the patient with complete continence and "failure" any type of involuntary stress urine leak, independently of its severity registering the time of its appearance. For this purpose we used the Kaplan-Meier analysis comparing both techniques with the Breslow test. Additionally, postoperative complications were evaluated. 128 patients who underwent surgery by TVT (69 patients, 53.9%) and TOT (59 patients, 46.1%). Mean age was 54.4 years for TVT (95% CI 52.0-56.8) and 59 years for TOT (95% CI 55.9-62.1). Mean follow-up time was 18.7 months for TVT (95% CI 15.6-21.9) and 7.4 months for TOT (95% CI 5.8-8.9). Overall continence rate was 86.7%, 88.4% for TVT and 84.7% for TOT The probability of being continent six months after surgery was 89.1% for TVT and 78.2% for TOT (no significant differences, p = 0.31), with almost all failures within the first six months after surgery. TVT was more frecuently associated with urgency symptoms (33.3%, p = 0.001) and urge incontinence (18.8%,p = 0.16), urinary retention (11.6%, p = 0.38), and prevesical hematoma requiring mesh retrieval. Greater post operative pain was observed with TOT (20.3%, p = 0.005). Our results evidence a similar efficacy with both techniques, with the failures appearing over the first months after surgery. Complications of the voiding urgency type are significantly more frequent with TVT.

Infrared fiber optic temperature monitoring of biological tissues heated in a microwave oven

NASA Astrophysics Data System (ADS)

Belotserkovsky, Edward; Ashkenasy, Y.; Shenfeld, Ofer; Drizlikh, S.; Zur, Albert; Katzir, Abraham

1993-05-01

The heating of tissue by microwave radiation has attained a place of importance in various medical fields such as the treatment of malignancies, urinary retention and hypothermia. Accurate temperature measurements in these treated tissues is important for treatment planning and for the control of the heating process. It is also important to be able to measure spacial temperature distribution in the tissues because they are heated in a non uniform way by the microwave radiation. Fiber optic radiometry makes possible accurate temperature measurement in the presence of microwave radiation and does not require contact with the tissue. Using a IR silver halide fiber optic radiometric temperature sensor we obtained accurate temperature measurements of tissues heated by microwave, enabling us to control the heating process in all regions of the tissue. We also performed temperature mapping of the heated tissues and demonstrated the non-uniform temperature distributions in them.

Laparoscopic cholecystectomy under epidural anesthesia: a clinical feasibility study.

PubMed

Lee, Ji Hyun; Huh, Jin; Kim, Duk Kyung; Gil, Jea Ryoung; Min, Sung Won; Han, Sun Sook

2010-12-01

Laparoscopic cholecystectomy (LC) has traditionally been performed under general anesthesia, however, owing in part to the advancement of surgical and anesthetic techniques, many laparoscopic cholecystectomies have been successfully performed under the spinal anesthetic technique. We hoped to determine the feasibility of segmental epidural anesthesia for LC. Twelve American Society of Anesthesiologists class I or II patients received an epidural block for LC. The level of epidural block and the satisfaction score of patients and the surgeon were checked to evaluate the efficacy of epidural block for LC. LC was performed successfully under epidural block, with the exception of 1 patient who required a conversion to general anesthesia owing to severe referred pain. There were no special postoperative complications, with the exception of one case of urinary retention. Epidural anesthesia might be applicable for LC. However, the incidence of intraoperative referred shoulder pain is high, and so careful patient recruitment and management of shoulder pain should be considered.

What's New in TIND?

PubMed

Marcon, Julian; Magistro, Giuseppe; Stief, Christian G; Grimm, Tobias

2018-04-26

There is growing interest in minimally invasive (MI) treatment options for male lower urinary tract symptoms (LUTS). Among these options, the temporary implantable nitinol device (TIND; Medi-Tate, Or Akiva, Israel) is a novel instrument used to alleviate symptoms by creating incisions in the prostate via mechanical stress. To review recent data for TIND as an MI procedure to improve LUTS. Medline, PubMed, the Cochrane Database, and Embase were screened for clinical trials, randomized controlled trials, and review articles on the use of TIND in patients with male LUTS. There are currently two studies available, one being a follow-up of the first pilot study. Both 12-mo and 36-mo results suggest at least medium-term effects of TIND in terms of symptom improvement (International Prostate Symptom Score, IPSS) and maximum urinary flow (Q max ). IPSS was improved by 41% after 12mo (p<0.001) and worsened only insignificantly after 36mo compared to baseline values. Q max increased by 4.4ml/s after 12mo (p<0.001) and did not decrease significantly after 36mo. Postoperative complications were mild and included urinary tract infection and urinary retention. Preliminary data suggest that TIND is a safe and effective MI technique for patients with male LUTS. Symptom relief and increase in urinary flow after 36mo are promising. However, long-term results are needed. Various treatment options for male patients suffering from urinary voiding symptoms are emerging. TIND, a temporary implantable nitinol device, appears to be a safe option that improves symptoms without affecting sexuality. Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Neuromodulation for the Treatment of Lower Urinary Tract Symptoms.

PubMed

Yamanishi, Tomonori; Kaga, Kanya; Fuse, Miki; Shibata, Chiharu; Uchiyama, Tomoyuki

2015-09-01

Neuromodulation therapy incorporates electrical stimulation to target specific nerves that control lower urinary tract symptoms (LUTS). The objectives of this article are to review the mechanism of action, the type of neuromodulation, and the efficacy of neuromodulation mainly according to the results of randomized controlled trials. Neuromodulation includes pelvic floor electrical stimulation (ES) using vaginal, anal and surface electrodes, interferential therapy (IF), magnetic stimulation (MS), percutaneous tibial nerve stimulation, and sacral nerve stimulation (SNS). The former four stimulations are used for external periodic (short-term) stimulation, and SNS are used for internal, chronic (long-term) stimulation. All of these therapies have been reported to be effective for overactive bladder or urgency urinary incontinence. Pelvic floor ES, IF, and MS have also been reported to be effective for stress urinary incontinence. The mechanism of neuromodulation for overactive bladder has been reported to be the reflex inhibition of detrusor contraction by the activation of afferent fibers by three actions, i.e., the activation of hypogastric nerve, the direct inhibition of the pelvic nerve within the sacral cord and the supraspinal inhibition of the detrusor reflex. The mechanism of neuromodulation for stress incontinence is contraction of the pelvic floor muscles through an effect on the muscle fibers as well as through the stimulation of pudendal nerves. Overall, cure and improvement rates of these therapies for urinary incontinence are 30-50, and 60-90% respectively. MS has been considered to be a technique for stimulating nervous system noninvasively. SNS is indicated for patients with refractory overactive bladder and urinary retention. © 2015 Wiley Publishing Asia Pty Ltd.

Urinary excretion of purine derivatives in Bos indicus x Bos taurus crossbred cattle.

PubMed

Ojeda, Alvaro; de Parra, Ornella; Balcells, Joaquím; Belenguer, Alvaro

2005-06-01

Four experiments were performed to study the kinetics of purine metabolism and urinary excretion in Zebu crossbred cattle. Fasting excretion was established in Expt 1, using eighteen male Bos indicus x Bos taurus crossbred cattle (261 (SE 9.1) kg body weight), six of each of the following genotypes: 5/8 Bos indicus, 1/2 Bos indicus and 3/8 Bos indicus. No significant differences were observed among genotypes in fasting purine derivative excretion (277.3 (SE 35.43) micromol/metabolic body weight). In a second experiment we measured the xanthine oxidase activity, which was higher in liver than in duodenal mucosa (0.64 and 0.06 (SE 0.12) units/g wet tissue per min respectively; P>0.05) being in plasma 0.60 (SE 0.36) units/l per min. The kinetics of uric acid were measured by intravenous pulse dose of [1,3-15N]uric acid (Expt 3). The cumulative recovery of the isotope in urine was 82 (SE 6.69) %, and uric acid plasma removal, pool size and mean retention time were 0.284 (SE 0.051) per h, 5.45 (SE 0.823) mmol and 3.52 (SE 0.521) h, respectively. Allantoin was removed from plasma at an estimated fractional rate of 0.273 (SE 0.081) per h and mean retention was 3.66 (SE 1.08) h. In Expt 4, the relationship between urinary purine derivative excretion (Y; mmol/d) and digestible organic matter intake (X, kg/d) was defined by the equation: Y=7.69 (SE 4.2)+5.69 (SE 1.68) X; n 16, Se 1.31, r 0.67.

First-in-Man Demonstration of Direct Endothelin-Mediated Natriuresis and Diuresis

PubMed Central

Hunter, Robert W.; Moorhouse, Rebecca; Farrah, Tariq E.; MacIntyre, Iain M.; Asai, Takae; Gallacher, Peter J.; Kerr, Debbie; Melville, Vanessa; Czopek, Alicja; Morrison, Emma E.; Ivy, Jess R.; Dear, James W.; Bailey, Matthew A.; Goddard, Jane; Webb, David J.

2017-01-01

Endothelin (ET) receptor antagonists are potentially novel therapeutic agents in chronic kidney disease and resistant hypertension, but their use is complicated by sodium and water retention. In animal studies, this side effect arises from ETB receptor blockade in the renal tubule. Previous attempts to determine whether this mechanism operates in humans have been confounded by the hemodynamic consequences of ET receptor stimulation/blockade. We aimed to determine the effects of ET signaling on salt transport in the human nephron by administering subpressor doses of the ET-1 precursor, big ET-1. We conducted a 2-phase randomized, double-blind, placebo-controlled crossover study in 10 healthy volunteers. After sodium restriction, subjects received either intravenous placebo or big ET-1, in escalating dose (≤300 pmol/min). This increased plasma concentration and urinary excretion of ET-1. Big ET-1 reduced heart rate (≈8 beats/min) but did not otherwise affect systemic hemodynamics or glomerular filtration rate. Big ET-1 increased the fractional excretion of sodium (from 0.5 to 1.0%). It also increased free water clearance and tended to increase the abundance of the sodium–potassium–chloride cotransporter (NKCC2) in urinary extracellular vesicles. Our protocol induced modest increases in circulating and urinary ET-1. Sodium and water excretion increased in the absence of significant hemodynamic perturbation, supporting a direct action of ET-1 on the renal tubule. Our data also suggest that sodium reabsorption is stimulated by ET-1 in the thick ascending limb and suppressed in the distal renal tubule. Fluid retention associated with ET receptor antagonist therapy may be circumvented by coprescribing potassium-sparing diuretics. PMID:28507171

Adherence of urease-induced crystals to rat bladder epithelium.

PubMed

Grenabo, L; Hedelin, H; Pettersson, S

1988-01-01

Apart from urine supersaturation with respect to struvite and calcium phosphate caused by urease-producing microorganisms, retention of formed crystals in the urinary tract is necessary for the formation of infection stones. This study was performed to investigate the role of the mucous coat lining the urothelium in the adhesion of urease-induced crystals. Removal of this glycosaminoglycan-containing layer from rat bladders increased the adherence of struvite and calcium phosphate crystals 5-6 times compared to that in intact rat bladders. Heparin completely restored the antiadherence capacity while chondroitin sulphate had a very weak restorative effect and human urine had no restorative effect. These findings support the view that the mucous coat is of importance in preventing retention of urease-induced crystals.

A rare cause of acute abdominal pain: Herlyn-Werner-Wunderlich syndrome.

PubMed

Aydin, Ramazan; Ozdemir, Ayse Zehra; Ozturk, Bahadir; Bilgici, Meltem Ceyhan; Tosun, Migraci

2014-01-01

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare müllerian duct anomaly with uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. Patients with this syndrome generally present after menarche with pelvic pain and mass and, rarely, primary infertility in later years. Strong suspicion and knowledge of this syndrome are mandatory for an accurate diagnosis. A 14-year-old female patient presented with acute retention of urine and abdominopelvic pain. Her condition was diagnosed with the use ultrasonography and magnetic resonance imaging as a case of HWW syndrome. She was treated with vaginal hemiseptal resection. The HWW syndrome should be considered among the differential diagnoses in girls with renal anomalies presenting with pelvic mass, symptoms of acute abdominal pain, and acute urinary retention.

Aspergillus vertebral osteomyelitis and epidural abscess.

PubMed

Tew, C W; Han, F C; Jureen, R; Tey, B H

2009-04-01

We present the first reported case of Aspergillus vertebral osteomyelitis and epidural abscess in Singapore in a 50-year-old man with post-tuberculous bronchiectasis. The patient presented with acute urinary retention and flaccid paraplegia. Despite surgical debridement and treatment with voriconazole, the patient developed multiorgan failure and died two weeks after presentation. Early diagnosis and prompt initiation of treatment are emphasised in the hope of improving the outcome of this aggressive condition.

The Effects of Concept Maps on the Academic Success and Attitudes of 11th Graders while Teaching Urinary System

ERIC Educational Resources Information Center

Akay, Sumeyye Ozbey; Kaya, Basturk; Kilic, Selda

2012-01-01

The aim of the present study is to support, enrich, and broaden the process of education using concept maps and to determine the effects of concept maps in biology classes on school success, attitude and retention of the knowledge taught. The present study was conducted as an experimental study with pre-test and post-test control groups. The…

Acid retention with reduced glomerular filtration rate increases urine biomarkers of kidney and bone injury.

PubMed

Wesson, Donald E; Pruszynski, Jessica; Cai, Wendy; Simoni, Jan

2017-04-01

Diets high in acid of developed societies that do not cause metabolic acidosis in patients with chronic kidney disease nevertheless appear to cause acid retention with associated morbidity, particularly in those with reduced glomerular filtration rate. Here we used a rat 2/3 nephrectomy model of chronic kidney disease to study induction and maintenance of acid retention and its consequences on indicators of kidney and bone injury. Dietary acid was increased in animals eating base-producing soy protein with acid-producing casein and in casein-eating animals with added ammonium chloride. Using microdialysis to measure the kidney cortical acid content, we found that nephrectomized animals had greater acid retention than sham-operated animals when both ate the soy diet. Each increment in dietary acid further increased acid retention more in nephrectomized than in sham rats. Nephrectomized and sham animals achieved similar steady-state daily urine net acid excretion in response to increments in dietary acid but nephrectomized animals took longer to do so, contributing to greater acid retention that was maintained until the increased dietary acid was stopped. Acid retention was associated with increased urine excretion of both N-acetyl-β-D-glucosaminidase and deoxypyridinoline, greater in nephrectomized than control rats, consistent with kidney tubulointerstitial and bone matrix injury, respectively. Greater acid retention in nephrectomized than control animals was induced by a slower increase in urinary net acid excretion rate in response to the increment in dietary acid and also maintained until the dietary acid increment was stopped. Thus, acid retention increased biomarkers of kidney and bone injury in the urine, supporting untoward consequences to these two tissues. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Nitrogen metabolism of sheep and goats consuming Acacia brevispica and Sesbania sesban

USGS Publications Warehouse

Woodward, A.; Reed, J.D.

1997-01-01

We described the effects of two East African browses, Acacia brevispica and Sesbania sesban, on nitrogen metabolism of sheep and goats. The A. brevispica had a substantial amount of proanthocyanidins (condensed tannins); S. sesban did not. The browses were fed at three levels in combination with vetch (Vicia dasycarpa) and teff straw (Eragrostis abyssinica). Fecal N, N balance, and plasma urea N (PUN) were estimated with intact animals. Ruminal ammonia (RuA) and VFA concentrations were estimated with ruminally fistulated animals. Urinary N loss, PUN, RuA, and VFA concentrations were higher for S. sesban diets than for A. brevispica diets. Fecal N was highest with diets including A. brevispica due to high levels of fecal neutral-detergent insoluble N. Nitrogen retention was highest for diets including S. sesban. Nitrogen retention was adequate for A. brevispica diets because low urinary N compensated for high fecal N. Four hypotheses describe possible effects of tannins on N metabolism: 1) escape of protein from the rumen to the lower tract; 2) increased microbial yield; 3) increase in N-containing endogenous products; and 4) protein made indigestible in tannin-protein complexes. The effect of tannins in A. brevispica on N metabolism can best be described by the formation of indigestible tannin-protein complexes, although increased production of endogenous products is also possible.

46 CFR 308.600 - Records retention requirement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Records retention requirement. 308.600 Section 308.600 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Records Retention § 308.600 Records retention requirement. The records specified in §§ 308.8, 308.517, and...

46 CFR 308.600 - Records retention requirement.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Records retention requirement. 308.600 Section 308.600 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Records Retention § 308.600 Records retention requirement. The records specified in §§ 308.8, 308.517, and...

46 CFR 308.600 - Records retention requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Records retention requirement. 308.600 Section 308.600 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Records Retention § 308.600 Records retention requirement. The records specified in §§ 308.8, 308.517, and...

46 CFR 308.600 - Records retention requirement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Records retention requirement. 308.600 Section 308.600 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Records Retention § 308.600 Records retention requirement. The records specified in §§ 308.8, 308.517, and...

46 CFR 308.600 - Records retention requirement.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Records retention requirement. 308.600 Section 308.600 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Records Retention § 308.600 Records retention requirement. The records specified in §§ 308.8, 308.517, and...

20 CFR 655.1319 - Document retention requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Document retention requirements. 655.1319... Employment in the United States (H-2A Workers) § 655.1319 Document retention requirements. (a) Entities... retention. Records and documents must be retained for a period of 3 years from the date of certification of...

40 CFR 80.1348 - What gasoline sample retention requirements apply to refiners and importers?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 17 2014-07-01 2014-07-01 false What gasoline sample retention... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Benzene Sampling, Testing and Retention Requirements § 80.1348 What gasoline sample retention requirements...

40 CFR 80.1348 - What gasoline sample retention requirements apply to refiners and importers?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 17 2013-07-01 2013-07-01 false What gasoline sample retention... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Benzene Sampling, Testing and Retention Requirements § 80.1348 What gasoline sample retention requirements...

40 CFR 80.1348 - What gasoline sample retention requirements apply to refiners and importers?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 16 2010-07-01 2010-07-01 false What gasoline sample retention... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Benzene Sampling, Testing and Retention Requirements § 80.1348 What gasoline sample retention requirements...

40 CFR 80.1348 - What gasoline sample retention requirements apply to refiners and importers?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 16 2011-07-01 2011-07-01 false What gasoline sample retention... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Benzene Sampling, Testing and Retention Requirements § 80.1348 What gasoline sample retention requirements...

40 CFR 80.1348 - What gasoline sample retention requirements apply to refiners and importers?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 17 2012-07-01 2012-07-01 false What gasoline sample retention... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Benzene Sampling, Testing and Retention Requirements § 80.1348 What gasoline sample retention requirements...

Low risk of perioperative infection without prophylactic antibiotics for transperineal prostate brachytherapy.

PubMed

Wallner, K; Roy, J; Harrison, L

1996-10-01

To determine the incidence of postimplant infection in patients who are not given prophylactic antibiotics (ATBs). One hundred thirty-one patients had computerized tomography (CT)-planned transperineal 125I implantation of the prostate from 1988 through 1995. One hundred fourteen of the patients did not receive prophylactic ATBs, 19 of whom required postimplant Foley catheter drainage for 1 day or more for acute urinary retention. The incidence of postimplant febrile episodes within 2 weeks of surgery among the patients who had not received prophylactic ATBs was 2 of 114 (2%). One of the two patients who developed postimplantation febrile episodes was treated successfully with ATBs as an outpatient. The second patient, who had a history of chronic lymphocytic leukemia (CLL) and immune suppression, developed E. coli sepsis and required intravenous antibiotics. Of 17 patients who received prophylactic ATBs, none had a postoperative febrile episode. We continue to refrain from routinely prescribing prophylactic ATBs unless there is some compelling circumstance including rheumatic heart disease, prosthetic devices, immune compromise, or a previous history of prostatitis.

Anesthesia for ambulatory anorectal surgery.

PubMed

Gudaityte, Jūrate; Marchertiene, Irena; Pavalkis, Dainius

2004-01-01

The prevalence of minor anorectal diseases is 4-5% of adult Western population. Operations are performed on ambulatory or 24-hour stay basis. Requirements for ambulatory anesthesia are: rapid onset and recovery, ability to provide quick adjustments during maintenance, lack of intraoperative and postoperative side effects, and cost-effectiveness. Anorectal surgery requires deep levels of anesthesia. The aim is achieved with 1) regional blocks alone or in combination with monitored anesthesia care or 2) deep general anesthesia, usually with muscle relaxants and tracheal intubation. Modern general anesthetics provide smooth, quickly adjustable anesthesia and are a good choice for ambulatory surgery. Popular regional methods are: spinal anesthesia, caudal blockade, posterior perineal blockade and local anesthesia. The trend in regional anesthesia is lowering the dose of local anesthetic, providing selective segmental block. Adjuvants potentiating analgesia are recommended. Postoperative period may be complicated by: 1) severe pain, 2) urinary retention due to common nerve supply, and 3) surgical bleeding. Complications may lead to hospital admission. In conclusion, novel general anesthetics are recommended for ambulatory anorectal surgery. Further studies to determine an optimal dose and method are needed in the group of regional anesthesia.

Outcomes of urethral calculi patients in an endemic region and an undiagnosed primary fossa navicularis calculus.

PubMed

Verit, Ayhan; Savas, Murat; Ciftci, Halil; Unal, Dogan; Yeni, Ercan; Kaya, Mete

2006-02-01

Urethral calculus is a rare form of urolithiasis with an incidence lower than 0.3%. We determined the outcomes of 15 patients with urethral stone, of which 8 were pediatric, including an undiagnosed primary fossa navicularis calculus. Fifteen consecutive male patients, of whom eight were children, with urethral calculi were assessed between 2000 and 2005 with a mean of 19 months' follow-up. All stones were fusiform in shape and solitary. Acute urinary retention, interrupted or weak stream, pain (penile, urethral, perineal) and gross hematuria were the main presenting symptoms in 7 (46.7%), 4 (26.7%), 3 (20%) and 1 (6.6%) patient, respectively. Six of them had accompanying urethral pathologies such as stenosis (primary or with hypospadias) and diverticulum. Two patients were associated with upper urinary tract calculi but none of them secondary to bladder calculi. A 50-year-old patient with a primary urethral stone disease had urethral meatal stenosis accompanied by lifelong lower urinary tract symptoms. Unlike the past reports, urethral stones secondary to bladder calculi were decreasing, especially in the pediatric population. However, the pediatric patients in their first decade are still under risk secondary to the upper urinary tract calculi or the primary ones.

Effects of specific inhibition of cyclooxygenase-2 on sodium balance, hemodynamics, and vasoactive eicosanoids.

PubMed

Catella-Lawson, F; McAdam, B; Morrison, B W; Kapoor, S; Kujubu, D; Antes, L; Lasseter, K C; Quan, H; Gertz, B J; FitzGerald, G A

1999-05-01

Conventional nonsteroidal anti-inflammatory drugs inhibit both cyclooxygenase (Cox) isoforms (Cox-1 and Cox-2) and may be associated with nephrotoxicity. The present study was undertaken to assess the renal effects of the specific Cox-2 inhibitor, MK-966. Healthy older adults (n = 36) were admitted to a clinical research unit, placed on a fixed sodium intake, and randomized under double-blind conditions to receive the specific Cox-2 inhibitor, MK-966 (50 mg every day), a nonspecific Cox-1/Cox-2 inhibitor, indomethacin (50 mg t.i.d.), or placebo for 2 weeks. All treatments were well tolerated. Both active regimens were associated with a transient but significant decline in urinary sodium excretion during the first 72 h of treatment. Blood pressure and body weight did not change significantly in any group. The glomerular filtration rate (GFR) was decreased by indomethacin but was not changed significantly by MK-966 treatment. Thromboxane biosynthesis by platelets was inhibited by indomethacin only. The urinary excretion of the prostacyclin metabolite 2,3-dinor-6-keto prostaglandin F1alpha was decreased by both MK-966 and indomethacin and was unchanged by placebo. Cox-2 may play a role in the systemic biosynthesis of prostacyclin in healthy humans. Selective inhibition of Cox-2 by MK-966 caused a clinically insignificant and transient retention of sodium, but no depression of GFR. Inhibition of both Cox isoforms by indomethacin caused transient sodium retention and a decline in GFR. Our data suggest that acute sodium retention by nonsteroidal anti-inflammatory drugs in healthy elderly subjects is mediated by the inhibition of Cox-2, whereas depression of GFR is due to inhibition of Cox-1.

Meal and beta-alanine coingestion enhances muscle carnosine loading.

PubMed

Stegen, Sanne; Blancquaert, Laura; Everaert, Inge; Bex, Tine; Taes, Youri; Calders, Patrick; Achten, Eric; Derave, Wim

2013-08-01

Beta-alanine (BA) is a popular ergogenic supplement because it can induce muscle carnosine loading. We hypothesize that, by analogy with creatine supplementation, 1) an inverse relationship between urinary excretion and muscle loading is present, and 2) the latter is stimulated by carbohydrate- and protein-induced insulin action. In study A, the effect of a 5-wk slow-release BA (SRBA) supplementation (4.8 g · d(-1)) on whole body BA retention was determined in seven men. We further determined whether the coingestion of carbohydrates and proteins with SRBA would improve retention. In study B (34 subjects), we explored the effect of meal timing on muscle carnosine loading (3.2 g · d(-1) during 6-7 wk). One group received pure BA (PBA) in between the meals; the other received PBA at the start of the meals, to explore the effect of meal-induced insulin release. Further, we compared with a third group receiving SRBA at the start of the meals. Orally ingested SRBA has a very high whole body retention (97%-98%) that is not declining throughout the 5-wk supplementation period, nor is it influenced by the coingestion of macronutrients. Thus, a very small portion (1%-2%) is lost through urinary excretion, and equally only a small portion is incorporated into muscle carnosine (≈ 3%), indicating that most ingested BA is metabolized (possibly through oxidation). Second, in soleus muscles, the efficiency of carnosine loading is significantly higher when PBA is coingested with a meal (+64%) compared with in between the meals (+41%), suggesting that insulin stimulates muscle carnosine loading. Finally, the chronic supplementation of SRBA versus PBA seems equally effective.

Neuroanatomic and behavioral correlates of urinary dysfunction induced by vaginal distension in rats.

PubMed

Palacios, J L; Juárez, M; Morán, C; Xelhuantzi, N; Damaser, M S; Cruz, Y

2016-05-01

The aim of the present study was to use a model of simulated human childbirth in rats to determine the damage to genitourinary structures and behavioral signs of urinary dysfunction induced by vaginal distension (VD) in female rats. In experiment 1, the length of the genitourinary tract and the nerves associated with it were measured immediately after simulated human delivery induced by VD or sham (SH) procedures. Electroneurograms of the dorsal nerve of the clitoris (DNC) were also recorded. In experiment 2, histological characteristics of the bladder and major pelvic ganglion of VD and SH rats were evaluated. In experiment 3, urinary parameters were determined in conscious animals during 6 h of dark and 6 h of light before and 3 days after VD or SH procedures. VD significantly increased distal vagina width (P < 0.001) and the length of the motor branch of the sacral plexus (P < 0.05), DNC (P < 0.05), and vesical nerves (P < 0.01) and decreased DNC frequency and amplitude of firing. VD occluded the pelvic urethra, inducing urinary retention, hematomas in the bladder, and thinness of the epithelial (P < 0.05) and detrusor (P < 0.01) layers of the bladder. Major pelvic ganglion parameters were not modified after VD. Rats dripped urine in unusual places to void, without the stereotyped behavior of micturition after VD. The neuroanatomic injuries after VD occur alongside behavioral signs of urinary incontinence as determined by a new behavioral tool for assessing micturition in conscious animals.

Surgical treatment of female stress urinary incontinence with a trans-obturator-tape (T.O.T.) Uratape: short term results of a prospective multicentric study.

PubMed

Costa, P; Grise, P; Droupy, S; Monneins, F; Assenmacher, C; Ballanger, P; Hermieu, J F; Delmas, V; Boccon-Gibod, L; Ortuno, C

2004-07-01

The aim of the study was to assess the efficacy and safety of a new minimally invasive surgical procedure using the Trans-Obturator-Tape Uratape to treat female stress urinary incontinence. 183 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (October 2001 to March 2003). 26 patients were previously operated for incontinence. 26 patients were operated at the same time for their genital prolapse. Mean age was 56 years (29-87). 50/183 patients were having mixed incontinence. A non-elastic, polypropylene tape (UraTape, Mentor-Porgès) with a silicon coated central part was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 7 months (1-21). At 1 year follow-up 80.5% of the patients were completely cured and 7.5% were improved. The overall peri-operative complication rate was 2.2% with no vascular, nerve or bowel injury. 6 patients (3.3%) had post-operative urinary retention. The present multicentric study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair. Copyright 2004 Elsevier B.V.

High-Dose-Rate Brachytherapy as a Monotherapy for Favorable-Risk Prostate Cancer: A Phase II Trial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barkati, Maroie; Williams, Scott G., E-mail: scott.williams@petermac.org; Department of Pathology, University of Melbourne, Melbourne

Purpose: There are multiple treatment options for favorable-risk prostate cancer. High-dose-rate (HDR) brachytherapy as a monotherapy is appealing, but its use is still investigational. A Phase II trial was undertaken to explore the value of such treatment in low-to-intermediate risk prostate cancer. Methods and Materials: This was a single-institution, prospective study. Eligible patients had low-risk prostate cancer features but also Gleason scores of 7 (51% of patients) and stage T2b to T2c cancer. Treatment with HDR brachytherapy with a single implant was administered over 2 days. One of four fractionation schedules was used in a dose escalation study design: 3more » fractions of 10, 10.5, 11, or 11.5 Gy. Patients were assessed with the Common Terminology Criteria for Adverse Events version 2.0 for urinary toxicity, the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scoring schema for rectal toxicity, and the Expanded Prostate Cancer Index Composite (EPIC) questionnaire to measure patient-reported health-related quality of life. Biochemical failure was defined as a prostate-specific antigen (PSA) nadir plus 2 ng/ml. Results: Between 2003 and 2008, 79 patients were enrolled. With a median follow-up of 39.5 months, biochemical relapse occurred in 7 patients. Three- and 5-year actuarial biochemical control rates were 88.4% (95% confidence interval [CI], 78.0-96.2%) and 85.1% (95% CI, 72.5-94.5%), respectively. Acute grade 3 urinary toxicity was seen in only 1 patient. There was no instance of acute grade 3 rectal toxicity. Rates of late grade 3 rectal toxicity, dysuria, hematuria, urinary retention, and urinary incontinence were 0%, 10.3%, 1.3%, 9.0%, and 0%, respectively. No grade 4 or greater toxicity was recorded. Among the four (urinary, bowel, sexual, and hormonal) domains assessed with the EPIC questionnaire, only the sexual domain did not recover with time. Conclusions: HDR brachytherapy as a monotherapy for favorable-risk prostate cancer, administered using a single implant over 2 days, is feasible and has acceptable acute and late toxicities. Further follow-up is still required to better evaluate the efficacy of such treatment.« less

Bilateral chronic sacral neuromodulation for treatment of lower urinary tract dysfunction.

PubMed

Hohenfellner, M; Schultz-Lampel, D; Dahms, S; Matzel, K; Thüroff, J W

1998-09-01

Chronic sacral neuromodulation aims at functional restoration of selected forms of nonneurogenic and neurogenic bladder dysfunction. The original technique, as described by Tanagho and Schmidt, provides unilateral sacral nerve stimulation via an implanted stimulator powering an electrode inserted into a sacral foramen. Its drawback was that the implant failed unpredictably in some patients despite previous successful percutaneous test stimulation. Therefore, we modified the stimulation technique to improve the efficacy of chronic sacral neuromodulation. Guarded bipolar electrodes powered by an implantable neurostimulator were attached bilaterally directly to the S3 nerves through a sacral laminectomy in 9 women and 2 men (mean age 43.4 years). Of the patients 5 had urinary incontinence due to detrusor hyperactivity and 6 had urinary retention from detrusor hypocontractility. Mean followup with repeated urodynamics was 13 months (range 9 to 28). Four significant complications were encountered in 4 patients. In 10 patients the urological sequelae of the neurological disorder were alleviated significantly (50% or more), including 5 who experienced complete relief of symptoms. The efficacy of chronic sacral neuromodulation can be improved by bilateral attachment of electrodes directly to the sacral nerves.

[The role of the uretral catheter in the development of catheter- related urinary tract infection].

PubMed

Vasilyev, A O; Govorov, A V; Shiryaev, A A; Pushkar, D Yu

2017-12-01

The most common source of nosocomial infection is the urinary tract, especially if they it is drained with a urethral catheter. Catheter-associated urinary tract infections account for at least 80% of all complicated urinary tract infections and are the most common type of hospital-acquired infection. Intestinal microflora plays the leading role in the pathogenesis of catheter-associated urinary tract infections, whereas the most important risk factor for their development is the long duration of urinary catheter drainage. In the case of short-term and intermittent catheterization, routine antibiotic prophylaxis is not required, but if a patient develops clinically significant infection, antibiotic therapy is required followed by definitive therapy based on culture. Urethral catheters coated with antimicrobial substances and anti-inflammatory agents can significantly reduce the adhesion and migration of bacteria, thereby reducing the incidence of urinary tract infections. Despite this, the incidence of catheter-associated infection remains high. We have reviewed recent literature related to catheter-associated urinary tract infections and the best means of preventing this condition.

Germanium in ginseng is low and causes no sodium and water retention or renal toxicity in the diuretic-resistant rats

PubMed Central

Tan, Chunjiang; Xiao, Lu; Chen, Wenlie

2015-01-01

Ginseng preparations contain high concentrations of germanium (Ge), which was reported to contribute to diuretic resistance or renal failure. However, Ge content in ginseng and the influence on renal functions remain unclear. Forty rats were randomly divided into control group, low, moderate, and high Ge ginseng-treated group and observed for 25 days. Daily urine, renal functions, and serum and urine electrolytics were measured. Ge retention in the organs and renal histological changes were also evaluated. Ge content ranged from 0.007 to 0.450 µg/g in various ginseng samples. Four groups showed no difference in the daily urine output, glomerular filtration rate, urinary electrolytes excretions, 24 h-urine protein, as well as plasma and urine urea nitrogen, creatinine, osmotic pressure, and pH values. Ge did not cause any renal pathological effects in this study. No Na and water retention was detected in the ginseng-treated groups. Ge retention in various organs was found highest in spleen, followed by the kidney, liver, lung, stomach, heart, and pancreas. The total Ge contents in various ginsengs were low, and ginseng treatment did not affect renal functions or cause renal histological changes. PMID:25711879

DOE Office of Scientific and Technical Information (OSTI.GOV)

Metivier, H.; Bourges, J.; Fritsch, P.

Absorption and retention of neptunium were determined in baboons after intragastric administration of neptunium nitrate solutions at pH 1. The effects of mass, diet, and fasting on absorption were studied. At higher mass levels (400-800 micrograms Np/kg), absorption was about 1%; at lower mass intakes (0.0009-0.005 micrograms Np/kg), absorption was reduced by 10- to 20-fold. The addition of an oxidizing agent (Fe3+) increased gastrointestinal absorption and supported the hypothesis of a reduction of Np (V) when loss masses were ingested. Diets depleted of or enriched with hydroxy acids did not modify retention of neptunium but increased urinary excretion with increasingmore » hydroxy acid content. The diet enriched with milk components reduced absorption by a factor of 5. Potatoes increased absorption and retention by a factor 5, not necessarily due to the effect of phytate. Fasting for 12 or 24 h increased retention and absorption by factors of about 3 and 10, respectively. Data obtained in baboons when low masses of neptunium were administered suggest that the f1 factor used by ICRP should be decreased. However, fasting as encountered in certain nutritional habits is a factor to be taken into consideration.« less

Apparent mineral retention is similar in control and hyperinsulinemic men after consumption of high amylose cornstarch.

PubMed

Behall, Kay M; Howe, Juliette C; Anderson, Richard A

2002-07-01

The effects on apparent mineral retention after long-term consumption of a high amylose diet containing 30 g resistant starch (RS) were investigated in 10 control and 14 hyperinsulinemic men. Subjects consumed products (bread, muffins, cookies, corn flakes and cheese puffs) made with standard (70% amylopectin, 30% amylose; AP) or high amylose (70% amylose, 30% amylopectin; AM) cornstarch for two 14-wk periods in a crossover pattern. Starch products replaced usual starches in the habitual diet for 10 wk followed by 4 wk of consuming the controlled diets. During wk 12, all urine, feces and duplicate foods were collected for 7 d. Urinary chromium losses after a glucose tolerance test or 24-h collections of the hyperinsulinemic and control subjects did not differ and were not altered by diet. Except for zinc, the two subject types did not differ significantly in apparent mineral balance. Apparent retentions of calcium and magnesium were not significantly affected by diet (AM vs. AP) or type-by-diet interaction. Apparent iron retention tended to be greater after AM than AP consumption (P < 0.09). Apparent copper retention was greater after consuming AP than after AM (P < 0.02), whereas apparent zinc retention was greater after consuming AM than after AP (P < 0.018). Zinc also showed a significant type-by-diet interaction (P < 0.034) with control subjects retaining less zinc after consuming AP than after AM. In summary, a high amylose cornstarch diet containing 30 g RS could be consumed long term without markedly affecting, and possibly enhancing, retention of some minerals.

Outcomes of intradetrusor onabotulinum toxin A injection in patients with Parkinson's disease.

PubMed

Vurture, Gregory; Peyronnet, Benoit; Feigin, Andrew; Biagioni, Milton C; Gilbert, Rebecca; Rosenblum, Nirit; Frucht, Steven; Di Rocco, Alessandro; Nitti, Victor W; Brucker, Benjamin M

2018-05-16

To assess the safety and efficacy of intradetrusor onabotulinum toxin A injections for the treatment of overactive bladder (OAB) in patients with Parkinson's disease (PD). All PD patients who underwent intradetrusor injections of onabotulinum toxin A (BoNT-A) for storage symptoms between 2010 and 2017 were included in a retrospective study. A 100 U dose of BoNT-A (Botox®, Allergan Irvine, CA) was used for the first injection in all patients. The primary endpoint was clinical success defined as any subjective improvement in OAB symptoms self-assessed by the patients 4 weeks after the injections. Out of 24 patients analyzed, 19 reported improvement of their OAB symptoms 4 weeks after the first injection (79.2%) with complete resolution of urgency urinary incontinence in seven patients (29.1%; P < 0.001). The average post-void residual (PVR) increased significantly after the first injection from 17.6 to 125.3 mL (P < 0.001). Three of the patients had to start clean intermittent catheterization (CIC) after the first injection (12.5%). Out of 49 injections in total, only five caused incomplete bladder emptying requiring the use of CIC (10.2%). Higher pre-injection PVR was significantly associated with both a lower chance of symptomatic improvement (P = 0.04) and a higher risk of incomplete bladder emptying with institution of CIC (P = 0.047). Intradetrusor injections of BoNT-A 100 U appeared as a safe and effective option in PD patients with OAB symptoms and a low PVR before the injection. Higher preoperative PVR was the strongest predictor of both treatment failure and postoperative urinary retention requiring CIC. © 2018 Wiley Periodicals, Inc.

Gender reassignment surgery in male-to-female transsexualism: A retrospective 3-month follow-up study with anatomical remarks.

PubMed

Jarolím, Ladislav; Šedý, Jiří; Schmidt, Marek; Naňka, Ondřej; Foltán, René; Kawaciuk, Ivan

2009-06-01

Greater acceptance of sexual minorities has enabled people with transsexualism access to adequate treatment and social integration. Gender reassignment surgery is a complex phase in the care of transsexual patients. In response to a greater volume of patients, surgical techniques have evolved and the outcome in patients with male-to-female transsexualism is now a very accurate imitation of female genitalia, enabling sexual intercourse with orgasm. To evaluate the results of surgical reassignment of genitalia in male-to-female transsexuals. A retrospective 3-month follow-up study of patients' opinions following gender reassignment surgery in 129 patients having a primary procedure (eight of whom had later sigmoideocolpoplasty) and five patients undergoing reoperation following an initial unsuccessful procedure at other units. All patients were male transsexuals. The surgical techniques are described in detail. Sexual functions and complications 3 months after surgery. All patients were satisfied with the first phase operation. Thirteen patients (9.7%) underwent successful sigmoideocolpoplasty. Main complications were as follows: rectal lesions developing during preparation of the vaginal canal (1.5%); bleeding from the stump of the shortened urethra in the first 48 hours postoperatively requiring secondary suturing (4.5%); temporary urinary retention requiring repeated insertion of urinary catheters for up to 6 days (5.2%); and healing of the suture between the perineum and the posterior aspect of the vaginal introitus healing by secondary intention (5.2%). The neoclitoris had erogenous sensitivity in 93.9% of patients and 65.3% reached orgasm in the first 3 months. Surgical conversion of the genitalia is a safe and important phase of the treatment of male-to-female transsexuals.

Diagnosis and treatment patterns of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia in Murjani General Hospital, Central Kalimantan, Indonesia.

PubMed

Raharjo, Robert Adrianto

2016-06-01

The aim of this study was to describe the diagnosis and treatment patterns of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and evaluate their appropriateness in an area without an urologist and with limited resources, such as the area covered by Murjani General Hospital, Sampit, Indonesia. This descriptive study used data collected from medical records of patients who were diagnosed with LUTS suggestive of BPH in Murjani General Hospital between September 2013 and August 2015. There were 89 patients. Their mean age was 64.5 years. The most common chief complaint was inability to void (59.6%), followed by frequency (10.1%). Diagnostic evaluations such as symptom scoring (1.1%), frequency-volume chart (0%), digital rectal examination (3.4%), urinalysis (5.6%), and prostate-specific antigen (0%) were used rarely or never, while renal function assessment (37.1%) and imaging of the prostate (68.5%) and upper urinary tract (65.2%) were used more often. Overall, the treatment that was administered most often was indwelling catheterization (25.8%); only 19.1% visited a urologist following a referral by the physician, although 41.6% were referred to a urologist. There were 40.4% of patients with an indication for surgery, mostly in the form of recurrent or refractory urinary retention (83.3%). In this group of patients, only 38.9% received appropriate treatment in the form of open prostatectomy by a general surgeon (16.7%) or were referred to a urologist (22.2%), while 50% of them were managed with chronic indwelling catheterization. All patients received substandard diagnostic evaluations, with a pattern of preference toward imaging studies over more basic examinations for LUTS-BPH. The high frequency of indwelling catheterization in overall and inappropriate treatment in the group of patients with an indication for surgery showed that patients received suboptimal treatment. Improvements in various aspects are required to optimize the management of LUTS suggestive of BPH in Murjani General Hospital.

32 CFR 34.42 - Retention and access requirements for records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Retention and access requirements for records. 34.42 Section 34.42 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... ORGANIZATIONS Post-award Requirements Reports and Records § 34.42 Retention and access requirements for records...

32 CFR 34.42 - Retention and access requirements for records.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 1 2011-07-01 2011-07-01 false Retention and access requirements for records. 34.42 Section 34.42 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... ORGANIZATIONS Post-award Requirements Reports and Records § 34.42 Retention and access requirements for records...

[External sphincterotomy using bipolar vaporisation in saline. First results].

PubMed

Even, L; Guillotreau, J; Mingat, N; Castel-Lacanal, E; Braley, E; Malavaud, B; Marque, P; Rischmann, P; Gamé, X

2012-07-01

The aim of this study was to assess the feasibility, efficacy and tolerance of external urethral sphincter vaporization in saline for treating detrusor-sphincter dyssynergia. Between 2009 and 2011 a monocentric prospective study of ten men mean age 58±9 years with neurogenic detrusor-sphincter dyssynergia was carried out. Preoperative evaluation included kidney ultrasound scan, 24-hour creatinine clearance, urodynamics, retrograde and voiding urethrocystography and an at least 6 months temporary stent sphincterotomy. Postoperative assessment was composed of an ultrasound scan post-void residual volume measurement when the urethral catheter were removed and 1 year after the procedure, a retrograde and voiding urethrocystography at 3 months and a flexible cystoscopy at 1 year. At the catheter removal, eight patients emptied their bladder at completion, a supra-pubic catheter was temporary left in one case and a patient had a permanent urinary retention. For a mean follow-up of 22±11 months, eight patients emptied their bladder at completion and two had a complete urinary retention related to a detrusor underactivity. An orchitis occurred in one case 1 month after the procedure and an urethral stricture in four cases in 12.75±5.68 months on average. External urethral sphincter vaporisation saline was feasible and efficient for treating detrusor-sphincter dyssynergia but was associated with a high risk of urethral stricture. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

ENaC activity in collecting ducts modulates NCC in cirrhotic mice.

PubMed

Mordasini, David; Loffing-Cueni, Dominique; Loffing, Johannes; Beatrice, Rohrbach; Maillard, Marc P; Hummler, Edith; Burnier, Michel; Escher, Geneviève; Vogt, Bruno

2015-12-01

Cirrhosis is a frequent and severe disease, complicated by renal sodium retention leading to ascites and oedema. A better understanding of the complex mechanisms responsible for renal sodium handling could improve clinical management of sodium retention. Our aim was to determine the importance of the amiloride-sensitive epithelial sodium channel (ENaC) in collecting ducts in compensate and decompensate cirrhosis. Bile duct ligation was performed in control mice (CTL) and collecting duct-specific αENaC knockout (KO) mice, and ascites development, aldosterone plasma concentration, urinary sodium/potassium ratio and sodium transporter expression were compared. Disruption of ENaC in collecting ducts (CDs) did not alter ascites development, urinary sodium/potassium ratio, plasma aldosterone concentrations or Na,K-ATPase abundance in CCDs. Total αENaC abundance in whole kidney increased in cirrhotic mice of both genotypes and cleaved forms of α and γ ENaC increased only in ascitic mice of both genotypes. The sodium chloride cotransporter (NCC) abundance was lower in non-ascitic KO, compared to non-ascitic CTL, and increased when ascites appeared. In ascitic mice, the lack of αENaC in CDs induced an upregulation of total ENaC and NCC and correlated with the cleavage of ENaC subunits. This revealed compensatory mechanisms which could also take place when treating the patients with diuretics. These compensatory mechanisms should be considered for future development of therapeutic strategies.

A grape-enriched diet increases bone calcium retention and cortical bone properties in ovariectomized rats.

PubMed

Hohman, Emily E; Weaver, Connie M

2015-02-01

Grapes and their associated phytochemicals have been investigated for beneficial effects on cardiovascular health, cancer prevention, and other chronic diseases, but the effect of grape consumption on bone health has not been fully determined. We previously found short-term benefits of grape products on reducing bone turnover in ovariectomized rats. The objective of this study was to determine the long-term benefits of a grape-enriched diet on bone in ovariectomized rats. Rats were ovariectomized at 3 mo of age and were administered a single dose of (45)Ca to prelabel bones at 4 mo of age. After a 1-mo equilibration period, baseline urinary (45)Ca excretion was determined. Rats (n = 22/group) were then randomly assigned to a modified AIN93M diet containing 25% freeze-dried grape powder or to a control diet for 8 wk. Urinary (45)Ca excretion was monitored throughout the study to determine changes in bone (45)Ca retention. Calcium balance was assessed after 1 and 8 wk of consuming the experimental diets, and a calcium kinetic study was performed at 8 wk. After 8 wk, femurs were collected for micro-computed tomographic imaging, 3-point bending, and reference point indentation. Rats fed the grape-enriched diet had 44% greater net bone calcium retention than did rats fed the control diet. There were no differences in calcium balance due to diet at either week 1 or week 8, but there was a significant increase in net calcium absorption (10.6%) and retention (5.7%) from week 1 to week 8 in the grape-enriched diet group only. Grape-enriched diet-fed rats had 3% greater cortical thickness and 11% greater breaking strength. There were no differences in femur bone mineral density, trabecular microarchitecture, or reference point indentation variables due to diet. This study of ovariectomized rats indicates that the consumption of grape products may improve calcium utilization and suppress bone turnover, resulting in improvements in bone quality. © 2015 American Society for Nutrition.

Complications and salvage options after laser lithotripsy for a vesical calculus in a tetraplegic patient: a case report.

PubMed

Vaidyanathan, Subramanian; Singh, Gurpreet; Selmi, Fahed; Hughes, Peter L; Soni, Bakul M; Oo, Tun

2015-01-01

Laser lithotripsy of vesical calculi in tetraplegic subjects with long-term urinary catheters is fraught with complications because of bladder wall oedema, infection, fragile urothelium, bladder spasms, and autonomic dysreflexia. Severe haematuria should be anticipated; failure to institute measures to minimise bleeding and prevent clot retention can be catastrophic. We present an illustrative case. A tetraplegic patient underwent laser lithotripsy of vesical stone under general anaesthesia. During lithotripsy, severe bladder spasms and consequent rise in blood pressure occurred. Bleeding continued post-operatively resulting in clot retention. CT revealed clots within distended but intact bladder. Clots were sucked out and continuous bladder irrigation was commenced. Bleeding persisted; patient developed repeated clot retention. Cystoscopy was performed to remove clots. Patient developed abdominal distension. Bladder rupture was suspected; bed-side ultrasound scan revealed diffuse small bowel dilatation with mild peritoneal effusion; under-filled bladder containing small clot. Patient developed massive abdominal distension and ileus. Two days later, CT with oral positive contrast revealed intra-peritoneal haematoma at the dome of bladder with perforation at the site of haematoma. Free fluid was noted within the peritoneal cavity. This patient was managed by gastric drainage and intravenous fluids. Patient's condition improved gradually with urethral catheter drainage. Follow-up CT revealed resolution of bladder rupture, perivesical haematoma, and intra-peritoneal free fluid. If bleeding occurs, bladder irrigation should be commenced immediately after surgery to prevent clot retention. When bladder rupture is suspected, CT of abdomen should be done instead of ultrasound scan, which may not reveal bladder perforation. It is debatable whether laparotomy and repair of bladder rupture is preferable to nonoperative management in tetraplegics. Anti-muscarinic drugs should be prescribed prior to lithotripsy to control bladder spasms; aspirin and ibuprofen should be omitted. If significant bleeding occurs during lithotripsy, procedure should be stopped and rescheduled. Percutaneous cystolithotripsy using a wide channel could be quicker to clear stones, as larger fragments could be retrieved; lesser stimulant for triggering autonomic dysreflexia, as it avoids urethral manipulation. But in patients with small, contracted bladder, and protuberant abdomen, percutaneous access to urinary bladder may be difficult and can result in injury to bowels.

The use of a pocket-sized ultrasound device improves physical examination: results of an in- and outpatient cohort study.

PubMed

Colli, Agostino; Prati, Daniele; Fraquelli, Mirella; Segato, Sergio; Vescovi, Pier Paolo; Colombo, Fabrizio; Balduini, Carlo; Della Valle, Serena; Casazza, Giovanni

2015-01-01

The performance of pocket mobile ultrasound devices (PUDs) is comparable with that of standard ultrasonography, whereas the accuracy of a physical examination is often poor requiring further tests to assess diagnostic hypotheses. Adding the use of PUD to physical examination could lead to an incremental benefit. We assessed whether the use of PUD in the context of physical examination can reduce the prescription of additional tests when used by physicians in different clinical settings. We conducted a cohort impact study in four hospital medical wards, one gastroenterological outpatient clinic, and 90 general practices in the same geographical area. The study involved 135 physicians who used PUD, after a short predefined training course, to examine 1962 consecutive patients with one of 10 diagnostic hypotheses: ascites, pleural effusion, pericardial effusion, urinary retention, urinary stones, gallstones, biliary-duct dilation, splenomegaly, abdominal mass, abdominal aortic aneurysm. According to the physicians' judgment, PUD examination could rule out or in the diagnostic hypothesis or require further testing; the concordance with the final diagnosis was assessed. The main outcome was the proportion of cases in which additional tests were required after PUD. The PUD diagnostic accuracy was assessed in patients submitted to further testing. The 1962 patients included 37% in-patients, 26% gastroenterology outpatients, 37% from general practices. Further testing after PUD examination was deemed unnecessary in 63%. Only 5% of patients with negative PUD not referred for further testing were classified false negatives with respect to the final diagnosis. In patients undergoing further tests, the sensitivity was 91%, and the specificity 83%. After a simple and short training course, a PUD examination can be used in addition to a physical examination to improve the answer to ten common clinical questions concerning in- and outpatients, and can reduce the need for further testing.

[Experiences in the treatment of benign prostatic hyperplasia with high power potassium-titanyl-phosphate (KTP) laser].

PubMed

Lipiński, Marek I; Peszyński-Drews, Cezary; Jeromin, Marek Z; Jeromin, Leszek M

2006-01-01

Benign prostatic hyperplasia (BPH) exist in about 70% men after 60 years old. High power KTP laser is a new tool for the treatment of BPH. 49 men were treated by photoselective vaporisation of the prostate (PVP) from August 2003 to May 2004. Thirty patients with follow-up period longer than 12 weeks (12 to 26 weeks) were analyzed. Preoperative prostate volume ranged from 31 to 136 cc. PSA range, estimated before treatment, was normal in all patients (pts). International Prostate Symptom Score (I-PSS) estimated before treatment was over 24 and Quality of Life (QoL) was over 3 in all pts. The maximum peak urinary flow (Qmax) before treatment ranged from 7.2 to 14.1 ml/s. One patient was catheterized with Foley catheter at the finish of the procedure. Two pts required catheterization in the first day after treatment. In two pts increasing of body temperature to 38 degrees C was observed in the first day after treatment. Twenty four hours after treatment haematuria required catheterization was observed in one patient. Seven days after treatment in 4 pts massive haematuria was observed (two required hospitalisation). In one patient because of urinary retention 4 weeks after PVP transurethral resection of the prostate was performed. Four weeks after PVP I-PSS decreased from 24 to 20 and after 12 weeks to 15. The Qmax increased and ranged from 11.3 ml/s to 17.1 ml/s 4 weeks after PVP and 12 weeks after PVP ranged from 15.1 to 22.8 ml/s. Photoselective vaporization of the prostate reduces I-PSS in all patients 12 weeks after procedure. Short follow-up period and a limited number of patients in study group cannot lead to ultimate conclusions. However the results encourage to undertaking further studies on PVP for the treatment of BPH.

40 CFR 31.42 - Retention and access requirements for records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... records. 31.42 Section 31.42 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND COOPERATIVE AGREEMENTS TO STATE AND LOCAL GOVERNMENTS Post-Award Requirements Reports, Records, Retention, and Enforcement § 31.42 Retention...

Transvaginal retropubic sling systems: efficacy and patient acceptability

PubMed Central

Moldovan, Christina P; Marinone, Michelle E; Staack, Andrea

2015-01-01

Stress urinary incontinence is a common, disabling, and costly medical problem that affects approximately 50% of women with urinary incontinence. Suburethral retropubic slings have been developed as a minimally invasive and effective surgical option, and they have been used as a first-line treatment for stress urinary incontinence since 1995. However, complications including vaginal extrusion, erosion, pain, bleeding, infections, lower urinary tract symptoms, urinary retention, and incontinence have been reported with use of the slings. Several companies manufacture sling kits, and the sling kits vary with regard to the composition of the mesh and introducer needle. The aim of this review was to determine which sling kit was most effective for patients, had minimal reported side effects, and was best accepted by patients and surgeons. In a review of the literature, it was found that a total of 38 studies were published between 1995 and 2014 that reported on eight tension-free retropubic sling kits: SPARC, RetroArc, Align, Advantage, Lynx, Desara, Supris, and Gynecare TVT. The Gynecare TVT was the most cited sling kit; the second most cited was the SPARC. This review provides a summary of the studies that have examined positive and negative outcomes of the retropubic tension-free suburethral sling procedure using various sling kits. Overall, the results of the literature review indicated that data from comparisons of the available sling kits are insufficient to make an evidenced-based recommendation. Therefore, the decision regarding which sling kit is appropriate to use in surgery is determined by the medical provider’s preference, training, and past experience, and not by the patient. PMID:25733928

A survey of trauma registrars: job requirements, responsibilities, recruitment, and retention.

PubMed

Day, Suzanne; Fox, Jolene; Cookman, Kathy

2012-01-01

Study purpose was to describe trauma registrar job requirements, responsibilities, and recruitment/retention practices. An online survey was used. One-third required a high school diploma; two-thirds required a college degree. Most required skills were medical terminology (66%), database management (65%), anatomy (64%), Word (63%). Data responsibilities included abstracting, entry, coding, and validating. Few employers required certification. Twenty-six percent reported problems with recruitment, and 35% with retention. Salary and lack of advancement were primary reasons for employee turnover. Certifications were less relevant than skills; the primary focus was data management. Recommendations for recruitment/retention include job flexibility, educational opportunities, and recognition as a profession.

40 CFR 80.1631 - Gasoline, RBOB, and CBOB sample retention requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 17 2014-07-01 2014-07-01 false Gasoline, RBOB, and CBOB sample... (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur § 80.1631 Gasoline, RBOB, and CBOB sample retention requirements. (a) Sample retention requirements. Beginning...

Comparison of clean intermittent and transurethral indwelling catheterization for the treatment of overt urinary retention after vaginal delivery: a multicentre randomized controlled clinical trial.

PubMed

Mulder, Femke E M; Hakvoort, Robert A; de Bruin, Jan P; van der Post, Joris A M; Roovers, Jan-Paul W R

2017-08-30

Overt postpartum urinary retention (PUR) is the inability to void after delivery and affects up to 7% of patients. Clean intermittent catheterization (CIC) and transurethral indwelling catheterization (TIC) are both standard treatments, but have not previously been compared. Clinical guidelines on postpartum bladder management are lacking. A total of 85 patients were randomised for TIC (n=45) and CIC (n=40). In total 68 patients (34 patients with TIC and 34 patients with CIC) completed the UDI-6 questionnaire 3 months after delivery.. Patients allocated to TIC received an indwelling catheter for 24 h and if necessary, another catheter for 48 h. Patients with CIC were intermittently catheterized or taught to self-catheterize until adequate voiding with a postvoid residual volume (PVRV) of <150 mL was achieved. The primary outcome was the presence of bothersome micturition symptoms as measured using the Dutch-validated Urogenital Distress Inventory (UDI-6). Only seven patients (10%) reported bothersome micturition problems 3 months after delivery. No significant differences in the occurrence of micturition symptoms were found. Median PVRV was 800 mL in the CIC group and 650 mL in the TIC group. PVRV was ≥1,000 mL in 24% of the patients. The median duration of catheterization was significantly shorter in the CIC group than in the TIC group (12 h vs. 24 h, p < 0,01). In patients with CIC, 35% required only one catheterization before complete bladder emptying occurred. The duration of treatment was not related to the initial PVRV. Both treatments were equally well accepted by the patients. In patients with overt PUR, CIC is the preferred treatment as a considerable percentage of patients appear to be over-treated when the standard duration of TIC is 24 h. The occurrence of micturition symptoms is not associated with the catheterization method used. CIC is well tolerated in patients with overt PUR.

49 CFR 219.901 - Retention of alcohol testing records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Retention of alcohol testing records. 219.901... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Recordkeeping Requirements § 219.901 Retention of alcohol testing records. (a) General requirement. In addition to the records required to be...

32 CFR 33.42 - Retention and access requirements for records.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 1 2014-07-01 2014-07-01 false Retention and access requirements for records. 33.42 Section 33.42 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... AGREEMENTS TO STATE AND LOCAL GOVERNMENTS Post-Award Requirements Reports, Records, Retention, and...

32 CFR 33.42 - Retention and access requirements for records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Retention and access requirements for records. 33.42 Section 33.42 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... AGREEMENTS TO STATE AND LOCAL GOVERNMENTS Post-Award Requirements Reports, Records, Retention, and...

32 CFR 33.42 - Retention and access requirements for records.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 1 2011-07-01 2011-07-01 false Retention and access requirements for records. 33.42 Section 33.42 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... AGREEMENTS TO STATE AND LOCAL GOVERNMENTS Post-Award Requirements Reports, Records, Retention, and...

32 CFR 33.42 - Retention and access requirements for records.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 1 2013-07-01 2013-07-01 false Retention and access requirements for records. 33.42 Section 33.42 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... AGREEMENTS TO STATE AND LOCAL GOVERNMENTS Post-Award Requirements Reports, Records, Retention, and...

49 CFR 219.903 - Retention of drug testing records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Retention of drug testing records. 219.903 Section... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Recordkeeping Requirements § 219.903 Retention of drug testing records. (a) General requirement. In addition to the records required to be kept...

49 CFR 219.903 - Retention of drug testing records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Retention of drug testing records. 219.903 Section... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Recordkeeping Requirements § 219.903 Retention of drug testing records. (a) General requirement. In addition to the records required to be kept...

49 CFR 219.903 - Retention of drug testing records.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Retention of drug testing records. 219.903 Section... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Recordkeeping Requirements § 219.903 Retention of drug testing records. (a) General requirement. In addition to the records required to be kept...

49 CFR 219.903 - Retention of drug testing records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Retention of drug testing records. 219.903 Section... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Recordkeeping Requirements § 219.903 Retention of drug testing records. (a) General requirement. In addition to the records required to be kept...

49 CFR 219.903 - Retention of drug testing records.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Retention of drug testing records. 219.903 Section... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Recordkeeping Requirements § 219.903 Retention of drug testing records. (a) General requirement. In addition to the records required to be kept...

The effects of crude protein concentration and slow release urea on nitrogen metabolism in Holstein steers.

PubMed

Holder, Vaughn B; El-Kadi, Samer W; Tricarico, Juan M; Vanzant, Eric S; McLeod, Kyle R; Harmon, David L

2013-04-01

This experiment was conducted to determine the effects of slow release urea (SRU) and its interaction with crude protein (CP) level in the diet on N metabolism in Holstein steers. Eight rumen-cannulated Holstein steers (body weight 265 ± 18 kg) were used in a replicated 4 × 4 Latin square design with a 2 × 2 factorial treatment structure. Treatment factors were the CP level in the diet, 10.9% versus 12.1% CP, and the non-protein nitrogen source used, urea versus SRU. Total collection of urine and faeces for 7 days allowed the estimation of N retention and diet digestibility. In addition, blood and rumen sampling allowed estimation of rumen fermentation and blood N profiles. Decreasing CP intake from 12.1% to 10.9% reduced urinary N output, but also reduced diet digestibility and N retention. When compared to urea, SRU did not alter N retention, but reduced ruminal ammonia and plasma urea concentrations. Although SRU did not improve N retention at either CP level, rumen ammonia and plasma urea concentrations were reduced, which may indicate that SRU may carry a lower risk for toxicity when compared to urea when fed at higher dietary concentrations.

Uterine Fibroids: Diagnosis and Treatment.

PubMed

De La Cruz, Maria Syl D; Buchanan, Edward M

2017-01-15

Uterine fibroids are common benign neoplasms, with a higher prevalence in older women and in those of African descent. Many are discovered incidentally on clinical examination or imaging in asymptomatic women. Fibroids can cause abnormal uterine bleeding, pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain, constipation, and dyspareunia. Ultrasonography is the preferred initial imaging modality. Expectant management is recommended for asymptomatic patients because most fibroids decrease in size during menopause. Management should be tailored to the size and location of fibroids; the patient's age, symptoms, desire to maintain fertility, and access to treatment; and the experience of the physician. Medical therapy to reduce heavy menstrual bleeding includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs. Gonadotropin-releasing hormone agonists or selective progesterone receptor modulators are an option for patients who need symptom relief preoperatively or who are approaching menopause. Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery.

Lumbar arthrodesis infection by multi-resistant Klebsiella pneumoniae, successfully treated with implant retention and ceftazidime/avibactam.

PubMed

Rico-Nieto, A; Moreno-Ramos, F; Fernández-Baillo, N

2018-04-07

There are increasingly more patients with prosthetic implants (orthopaedic prostheses, lumbar instruments, osteosynthesis material). In the last decade, infections caused by carbapenem resistant Enterobacteriaceae have increased (bacteriaemia, abscesses, urinary tract infections...) with great difficulty in treatment and important associated comorbidity. We present the first case of infection of a lumbar instrumentation by Klebsiella pneumoniae producing carbapenemase D, OXA-48 type, and successfully treated. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Influence of injected caffeine on the metabolism of calcium and the retention and excretion of sodium, potassium, phosphorus, magnesium, zinc and copper in rats.

PubMed

Yeh, J K; Aloia, J F; Semla, H M; Chen, S Y

1986-02-01

Mineral metabolism was studied by the metabolic balance technique in rats with and without administration of caffeine. Caffeine was injected subcutaneously each day at either 2.5 mg or 10 mg/100 g body weight for 2 wk before the balance studies. Urinary volume excretion was higher in the group given caffeine than in the control group, but the creatinine clearance was not different. Urinary excretion of potassium, sodium, inorganic phosphate, magnesium and calcium, but not of zinc and copper, was also higher in the rats given caffeine. The rank order of the difference was the same as the percent of ingested mineral excreted in urine in the absence of caffeine. Caffeine caused a negative balance of potassium, sodium and inorganic phosphate. There was no significant difference from the control levels and in the apparent metabolic balance of calcium and magnesium. The urinary and fecal excretion of zinc and copper were found to be unaffected by caffeine. It is suggested that chronic administration of caffeine may lead to a tendency toward deficiency of those minerals that are excreted primarily in urine.

A novel reversed-phase HPLC method for the determination of urinary creatinine by pre-column derivatization with ethyl chloroformate: comparative studies with the standard Jaffé and isotope-dilution mass spectrometric assays.

PubMed

Leung, Elvis M K; Chan, Wan

2014-02-01

Creatinine is an important biomarker for renal function diagnosis and normalizing variations in urinary drug/metabolites concentration. Quantification of creatinine in biological fluids such as urine and plasma is important for clinical diagnosis as well as in biomonitoring programs and urinary metabolomics/metabonomics research. Current methods for creatinine determination either are nonselective or involve the use of expensive mass spectrometers. In this paper, a novel reversed-phase high-performance liquid chromatographic (HPLC) method for the determination of creatinine of high hydrophilicity by pre-column derivatization with ethyl chloroformate is presented. N-Ethyloxycarbonylation of creatinine significantly enhanced the hydrophobicity of creatinine, facilitating its chromatographic retention as well as quantification by HPLC. Factors governing the derivatization reaction were studied and optimized. The developed method was validated and applied for the determination of creatinine in rat urine samples. Comparative studies with isotope-dilution mass spectrometric method revealed that the two methods do not yield systematic differences in creatinine concentrations, indicating the HPLC method is suitable for the determination of creatinine in urine samples.

The role of chronic prostatic inflammation in the pathogenesis and progression of benign prostatic hyperplasia (BPH).

PubMed

Gandaglia, Giorgio; Briganti, Alberto; Gontero, Paolo; Mondaini, Nicola; Novara, Giacomo; Salonia, Andrea; Sciarra, Alessandro; Montorsi, Francesco

2013-08-01

Several different stimuli may induce chronic prostatic inflammation, which in turn would lead to tissue damage and continuous wound healing, thus contributing to prostatic enlargement. Patients with chronic inflammation and benign prostatic hyperplasia (BPH) have been shown to have larger prostate volumes, more severe lower urinary tract symptoms (LUTS) and a higher probability of acute urinary retention than their counterparts without inflammation. Chronic inflammation could be a predictor of poor response to BPH medical treatment. Thus, the ability to identify patients with chronic inflammation would be crucial to prevent BPH progression and develop target therapies. Although the histological examination of prostatic tissue remains the only available method to diagnose chronic inflammation, different parameters, such as prostatic calcifications, prostate volume, LUTS severity, storage and prostatitis-like symptoms, poor response to medical therapies and urinary biomarkers, have been shown to be correlated with chronic inflammation. The identification of patients with BPH and chronic inflammation might be crucial in order to develop target therapies to prevent BPH progression. In this context, clinical, imaging and laboratory parameters might be used alone or in combination to identify patients that harbour chronic prostatic inflammation. © 2013 BJU International.

Long-term micturition problems of asymptomatic postpartum urinary retention: a prospective case-control study.

PubMed

Mulder, Femke E M; Hakvoort, Robert A; de Bruin, Jan-Peter; Janszen, Erica W; van der Post, Joris A M; Roovers, Jan-Paul W R

2018-04-01

Covert (asymptomatic) postpartum urinary retention (PUR) is defined as post-void residual volume (PVRV) ≥150 mL. Although often supposed to be a common and harmless phenomenon, no data are available on the potential long-term micturition problems of increased PVRV after vaginal delivery. After the first spontaneous void post-vaginal delivery, PVRV was measured using a portable scanning device. Micturition symptoms were compared using validated questionnaires between women with PVRV < 150 mL and those with PVRV ≥150 mL until 1 year after delivery. Women with PVRV ≥ 150 mL were followed until complete bladder emptying was achieved. Data of 105 patients with PVRV < 150 mL and 119 with PVRV ≥ 150 mL were available for analysis. 75% of all patients included had PVRV ≥ 250 mL. More primiparous patients had PVRV ≥ 150 mL (p < 0.02). 92% of women with PVRV ≥ 150 mL after delivery were able to adequately empty their bladder within 4 days. One year after delivery, no statistically significant differences were found. Covert PUR according to the definition of PVRV ≥ 150 mL, is a common and transient phenomenon that does not result in more lower urinary tract symptoms 1 year after delivery. Although the current definition is not useful in identifying postpartum women with a pathological condition, we suggest that the definition of covert PUR should be change to: "PVRV≥500 mL after the first spontaneous void after (vaginal) delivery." This cut-off value is the value at which some women do need more time to normalise emptying of the bladder. The exact clinical implications of covert PUR need to be further studied in this subcategory of women.

Effects of potassium chloride and potassium bicarbonate in the diet on urinary pH and mineral excretion of adult cats.

PubMed

Passlack, Nadine; Brenten, Thomas; Neumann, Konrad; Zentek, Jürgen

2014-03-14

Low dietary K levels have been associated with increasing renal Ca excretion in humans, indicating a higher risk of calcium oxalate (CaOx) urolith formation. Therefore, the present study aimed to investigate whether dietary K also affects the urine composition of cats. A total of eight adult cats were fed diets containing 0·31 % native K and 0·50, 0·75 and 1·00 % K from KCl or KHCO₃ and were evaluated for the effects of dietary K. High dietary K levels were found to elevate urinary K concentrations (P<0·001). Renal Ca excretion was higher in cats fed the KCl diets than in those fed the KHCO₃ diets (P=0·026), while urinary oxalate concentrations were generally lower in cats fed the KCl diets and only dependent on dietary K levels in cats fed the KHCO₃ diets (P<0·05). Fasting urine pH increased with higher dietary K levels (P=0·022), reaching values of 6·38 (1·00 % KCl) and 7·65 (1·00 % KHCO₃). K retention was markedly negative after feeding the cats with the basal diet (-197 mg/d) and the 0·50 % KCl diet (-131 mg/d), while the cats tended to maintain their balance on being fed the highest-KCl diet (-23·3 mg/d). In contrast, K from KHCO₃ was more efficiently retained (P=0·018), with K retention being between -82·5 and 52·5 mg/d. In conclusion, the dietary inclusion of KHCO₃ instead of KCl as K source could be beneficial for the prevention of CaOx urolith formation in cats, since there is an association between a lower renal Ca excretion and a generally higher urine pH. The utilisation of K is distinctly influenced by the K salt, which may be especially practically relevant when using diets with low K levels.

The risk of urinary retention following robot-assisted radical prostatectomy and its impact on early continence outcomes.

PubMed

Alnazari, Mansour; Zanaty, Marc; Ajib, Khaled; El-Hakim, Assaad; Zorn, Kevin C

2017-12-22

We aimed to evaluate the risk factors of acute urinary retention (AUR) following robot-assisted radical prostatectomy (RARP), as well as the relationship of AUR with early continence outcomes. The records of 740 consecutive patients who underwent RARP by two experienced surgeons at our institution were retrospectively reviewed from a prospectively collected database. Multiple factors, including age, body mass index (BMI), international prostate symptom score (IPSS), prostate volume, presence of median lobe, nerve preservation status, anastomosis time, and catheter removal time (Day 4 vs. 7), were evaluated as risk factors for AUR using univariate and multivariate analysis. The relation between AUR and early return of continence (one and three months) post-RARP was also evaluated. The incidence of clinically significant vesico-urethral anastomotic (VUA) leak and AUR following catheter removal were 0.9% and 2.2% (17/740), respectively. In men who developed AUR, there was no significant relationship with regards to age, BMI, IPSS, prostatic volume, median lobe, nerve preservation, or anastomosis time; however, the incidence of AUR was significantly higher for men with catheter removal at Day 4 (4.5% [16/351]) vs. Day 7 (0.2% [1/389]) (p=0.004). Moreover, patients with early removal of the catheter (Day 4) who developed AUR had an earlier one-month return of 0-pad continence 87.5% (14/16) compared to patients without AUR 45.6% (153/335), with no significant difference at three months. While AUR is an uncommon complication of RARP, its incidence is much higher than VUA leakage. Further, it is often not well-discussed during patient counselling preoperatively. Moreover, earlier return of urinary continence was observed in patients experiencing AUR following RARP exclusively with catheter removal at Day 4. Future studies are warranted to validate the long-term impact of AUR on continence outcomes.

Impact of two types of complete pelleted, wild ungulate feeds and two pelleted feed to hay ratios on the development of urolithogenic compounds in meat goats as a model for giraffes.

PubMed

Sullivan, K; Freeman, S; van Heugten, E; Ange-van Heugten, K; Wolfe, B; Poore, M H

2013-06-01

Urolith formation has been documented in giraffes and goats. As research in giraffes poses logistical challenges, 16 buck goats were used as a model. The impact of two commercially available, pelleted feeds used for giraffes, ADF-16 and Wild Herbivore (WH), as well as the impact of alfalfa hay and pellet proportions (20% hay:80% pellets, 80P or 80% hay:20% pellet, 20P) on the formation of urolithogenic precursors in goat urine was accomplished in a 2 × 2 factorial balance study. Complete diets contained 0.60, 0.32, 0.35 and 0.26% phosphorus (P) with calcium:P ratios of 1.60, 4.16, 3.06 and 5.23, for 80P-ADF-16, 20P-ADF-16, 80P-WH and 20P-WH respectively. Total faeces and urine were collected over two 5-day periods to assess N and mineral balance. Fresh urine samples were collected and evaluated microscopically for urolithic crystal content. Urinary nitrogen (N) was lower and N retention was higher in goats fed 80P diets (p < 0.05). Intake of P was greatest for goats fed 80P-ADF-16; however, urinary P excretion and P retention were not affected by treatment. Crystal scores were higher in animals receiving 80P diets (p = 0.08), with crystals being composed predominantly of calcium phosphate. Urine pH was alkaline (>8) for all treatments. Urinary P concentration, a risk factor for urolithiasis, was highest (p ≤ 0.06) in the 80P-ADF-16 treatment (0.38 vs. 0.01, 0.02 and 0.04 mg/dl for 20P-ADF-16, 80P-WH and 20P-WH respectively), reflecting its highest dietary P level. Further investigation is recommended to determine the long-term effects of these diets on urolithogenic compound formation. © 2012 Blackwell Verlag GmbH.

Safety and Effectiveness of Mirabegron in Patients with Overactive Bladder in a Real-World Clinical Setting: A Japanese Post-Marketing Study.

PubMed

Nozawa, Yumiko; Kato, Daisuke; Tabuchi, Hiromi; Kuroishi, Kentarou

2018-05-01

To provide real-world data on Japanese patients with overactive bladder (OAB) initiating treatment with the β 3 -adrenoceptor agonist, mirabegron. This study examined prescribing patterns, adverse drug reaction (ADR) incidence, and treatment effectiveness. Full medical histories, including prior/concomitant drug use, were collected before initiating mirabegron treatment. After 12 weeks mirabegron, physicians assessed ADR incidence and treatment effectiveness. Residual urine volume was assessed and patients completed the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score-Quality of Life (I-PSS QoL) surveys at Baseline and 12 weeks. Data were collected between April 2012 and July 2014. Of 9795 OAB patients (46.8% male; 80.8% ≥65 years), 71.7% had coexisting disease [notably benign prostatic hyperplasia (BPH, 32.4%), hypertension (31.9%), and diabetes mellitus (9.4%)] and 53.4% reported concomitant drug use (27.8% α 1 -antagonists, 6.3% anticholinergics). The incidence of total ADRs was 6.07% [including constipation (0.97%), thirst (0.47%), and dysuria (0.44%)], of serious ADRs, 0.21%, of cardiovascular ADRs, 0.48% and of urinary retention, 0.31%. Incidence of total ADRs in patients with concomitant cardiovascular disease was 10.09% and of those related to urinary retention in men with untreated BPH, 0.88%. After 12 weeks treatment, physicians judged mirabegron as "effective" in 80.7% of patients, 63.6% of patients achieved the three-point minimal clinically important change from Baseline in the mean OABSS, and the I-PSS QoL decreased significantly from Baseline (-2.1 ± 1.77; P < 0.001). In the clinical setting, mirabegron is well tolerated, with no unanticipated ADRs, and is an effective treatment for Japanese patients with OAB. © 2016 Astellas Pharma Inc. LUTS: Lower Urinary Tract Symptoms published by John Wiley & Sons Australia, Ltd.

Protein requirements of finishing paca (Cuniculus paca).

PubMed

Nogueira-Filho, Sérgio Luiz Gama; Bastos, Ivanise da Hora; Mendes, Alcester; Nogueira, Selene Siqueira da Cunha

2016-06-01

We conducted a nitrogen balance digestion trial to determine the crude protein requirements of paca (Cuniculus paca) during the last growth phase. In a 4 × 4 Latin square design, four young captive male pacas, aged 5 months, were fed four isoenergetic diets containing four different levels of nitrogen (N) (11.3, 16.6, 21.4, and 26.6 g N/kg of dry matter). After 15 days of adaptation, we collected all feces and urine for five consecutive days. By regression analysis between N intake and N in feces and urine, the metabolic fecal nitrogen (MFN = 4.2 g/kg of dry matter intake) and daily endogenous urinary N (EUN = 91.6 mg/kg(0.75)) were determined. Likewise, by regression analyses between nitrogen intake and nitrogen retention [NR = N intake-(fecal N + urine N)], we estimated the daily requirement of 280.5 mg N/kg(0.75). Therefore, a minimum of 55 g crude protein per kilogram dry matter and 13 MJ/kg of digestible energy are required by finishing paca on unrestricted diets. Such values are similar to those of other wild frugivores and below those of growing rabbits. The data confirm that farmers overfeed protein, and similar growth can be more economically achieved on lower protein diets.

Prostatron 30-minute update: where do we stand

NASA Astrophysics Data System (ADS)

Ulchaker, James C.; Albani, Justin

2003-06-01

The urologic management of benign prostatic hyperplasia (BPH) beyond pharmaco-therapy has changed dramatically over the last decade. Open prostatectomy and transurethral resection of the prostate (TURP) have been the mainstays of surgical intervention for BPH. These procedures were initially reserved for patients with obstructive uropathy, prostatic bleeding, or bladder calculi. With improved techniques and lower morbidity, TURP is currently the "gold standard" of treatment for patients with BPH and troubling lower urinary tract symptoms (LUTS), and patients are being treated prior to the development of these adverse sequelae. Nevertheless, TURP is still major surgery, requiring either a spinal or general anesthetic and an inpatient hospital stay. Furthermore, TURP is not uniformly successful. Up to 30% of patients report dissatisfaction from the procedure. Complications have been well described and include bleeding, bladder-neck contracture, erectile dysfunction retrograde ejaculation, urinary incontinence, and fluid/electrolyte imbalance (post-TUR syndrome). The mortality rate for TURP is approx. 2 - 10/1000 cases. Over the past decade, the number of TURPs being performed has been decreasing as minimally invasive therapies, including alpha-adrenergic blockers, are being used as "first-line" management with increasing frequency and success. In addition, urologists no longer just treat ill patients in urinary retention. The treatment paradigm has evolved to include patients with persistently troubling symptoms of bladder-outlet obstruction, prior to the development of such adverse sequelae. Furthermore, patients see the care of a urologist on an elective basis, and they frequently wish to avoid surgery. As described in prior chapters, advancements in our understanding of the pathophysiology of BPH have led toimprovements in its medical management and have delayed or precluded surgery in many patients. However, when pharmacotherapy fails, further treatment options need to be discussed. Minimally invasive therapies for BPH have evolved out of this need to "bridge the gap" between medical and surgical managment. This chapter describes the current modalities of minimally invasive treatment for benign prostatic obstruction caused by prostatic lobar hyperplasia, and their respective roles in our office practice.

Determination of free cortisol and free cortisone in human urine by on-line turbulent flow chromatography coupled to fused-core chromatography-tandem mass spectrometry (TFC-HPLC-MS/MS).

PubMed

Sánchez-Guijo, Alberto; Hartmann, Michaela F; Shi, Lijie; Remer, Thomas; Wudy, Stefan A

2014-01-01

Urinary free cortisol and urinary free cortisone are decisive markers for the diagnosis of syndromes related to the dysfunction of the adrenal gland or to evaluate certain enzymatic disorders. Here, we present a new method, designed for routine laboratory use, which enables quick determination of these analytes with minor sample workup. Turbulent flow chromatography shortens sample preparation, and connection to a fused-core particle-packed column (rugged amide-embedded C18 phase) permits a rapid and effective separation of the analytes, as well as additional separation from other related and isobaric compounds present in urine. Urinary isobaric compounds were successfully identified. The method requires only 100 μl of urine supernatant per sample. The total time between injections is 9.5 min. The solvents used for both turbulent and analytical chromatography are water and methanol, and the relatively low flows needed during the method resulted in an extended life of the columns. Linearity showed a R (2) > 0.994. Limit of detection and limit of quantification are 0.5 and 1.0 ng/ml for cortisone and 1.0 and 2.0 ng/ml for cortisol. Recoveries ranged from 99.7 to 109.1 % for cortisone and from 98.7 to 102.9 % for cortisol. Accuracy values (relative errors) for intra- and inter-assay experiments were always below 8 %, whereas precision (percent CV) ranged from 3.7 to 10.7 %. No matrix effects were detected during the validation process. The reproducibility for each analyte's retention time was excellent, with a coefficient of variation always below 0.2 %. The final validation step included the study of urine samples from healthy children and from children previously diagnosed with corticoidal disorders. The high selectivity achieved enables quick data handling.

Urinary Excretion of Sodium, Nitrogen, and Sugar Amounts Are Valid Biomarkers of Dietary Sodium, Protein, and High Sugar Intake in Nonobese Adolescents.

PubMed

Moore, Lori B; Liu, Sarah V; Halliday, Tanya M; Neilson, Andrew P; Hedrick, Valisa E; Davy, Brenda M

2017-12-01

Background: Objective indicators of dietary intake (e.g., biomarkers) are needed to overcome the limitations of self-reported dietary intake assessment methods in adolescents. To our knowledge, no controlled feeding studies to date have evaluated the validity of urinary sodium, nitrogen, or sugar excretion as dietary biomarkers in adolescents. Objective: This investigation aimed to evaluate the validity of urinary sodium, nitrogen, and total sugars (TS) excretion as biomarkers for sodium, protein, and added sugars (AS) intake in nonobese adolescents. Methods: In a crossover controlled feeding study design, 33 adolescents [12-18 y of age, 47 ± 25th percentile (mean ± SD) of body mass index (BMI; in kg/m 2 ) for age] consumed 5% AS [low added sugars (LAS)] and 25% AS [high added sugars (HAS)] isocaloric, macronutrient-matched (55% carbohydrate, 30% fat, and 15% protein) diets for 7 d each, in a randomly assigned order, with a 4-wk washout period between diets. On the final 2 d of each diet period, 24-h urine samples were collected. Thirty-two adolescents completed all measurements (97% retention). Results: Urinary sodium was not different from the expected 90% recovery (mean ± SD: 88% ± 18%, P = 0.50). Urinary nitrogen was correlated with protein intake ( r = 0.69, P < 0.001), although it was below the 80% expected recovery (62% ± 7%, P < 0.001). Urinary TS values were correlated with AS intake during the HAS diet ( r = 0.77, P < 0.001) and had a higher R 2 value of 0.28 than did AS intake ( R 2 = 0.36). TS excretion differed between LAS (0.226 ± 0.09 mg/d) and HAS (0.365 ± 0.16 mg/d) feeding periods ( P < 0.001). Conclusions: Urinary sodium appears to be a valid biomarker for sodium intake in nonobese adolescents. Urinary nitrogen is associated with protein intake, but nitrogen excretion rates were less than previously reported for adults, possibly owing to adolescent growth rates. TS excretion reflects AS at 25% AS intake and was responsive to the change in AS intake. Thus, urinary biomarkers are promising objective indicators of dietary intake in adolescents, although larger-scale feeding trials are needed to confirm these findings. This trial was registered at clinicaltrials.gov as NCT02455388. © 2017 American Society for Nutrition.

29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 9 2011-07-01 2011-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance and...

29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 9 2014-07-01 2014-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance and...

29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance and...

29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 9 2013-07-01 2013-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance and...

29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 9 2012-07-01 2012-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance and...

Effects of chronic fructose overload on renal dopaminergic system: alteration of urinary L-dopa/dopamine index correlates to hypertension and precedes kidney structural damage.

PubMed

Rukavina Mikusic, Natalia L; Kouyoumdzian, Nicolás M; Del Mauro, Julieta S; Cao, Gabriel; Trida, Verónica; Gironacci, Mariela M; Puyó, Ana M; Toblli, Jorge E; Fernández, Belisario E; Choi, Marcelo R

2018-01-01

Insulin resistance induced by a high-fructose diet has been associated to hypertension and renal damage. The aim of this work was to assess alterations in the urinary L-dopa/dopamine ratio over three time periods in rats with insulin resistance induced by fructose overload and its correlation with blood pressure levels and the presence of microalbuminuria and reduced nephrin expression as markers of renal structural damage. Male Sprague-Dawley rats were randomly divided into six groups: control (C) (C4, C8 and C12) with tap water to drink and fructose-overloaded (FO) rats (FO4, FO8 and FO12) with a fructose solution (10% w/v) to drink for 4, 8 and 12 weeks. A significant increase of the urinary L-dopa/dopamine ratio was found in FO rats since week 4, which positively correlated to the development of hypertension and preceded in time the onset of microalbuminuria and reduced nephrin expression observed on week 12 of treatment. The alteration of this ratio was associated to an impairment of the renal dopaminergic system, evidenced by a reduction in renal dopamine transporters and dopamine D1 receptor expression, leading to an overexpression and overactivation of the enzyme Na + , K + -ATPase with sodium retention. In conclusion, urinary L-dopa/dopamine ratio alteration in rats with fructose overload positively correlated to the development of hypertension and preceded in time the onset of renal structural damage. This is the first study to propose the use of the urinary L-dopa/dopamine index as marker of renal dysfunction that temporarily precedes kidney structural damage induced by fructose overload. Copyright © 2017 Elsevier Inc. All rights reserved.

Bacterial factors in the formation of renal scars. An experimental study on the role of Escherichia coli P-fimbriation and hydrophobicity.

PubMed

Arnold, A J; Sunderland, D; Rickwood, A M; Hart, C A

1993-11-01

A model capable of comparing the effects of bacterial virulence factors on renal scarring in vivo has been developed using the female piglet. By creating, at open surgery, unilateral vesicoureteric reflux (VUR) and quantifying scarring both by uptake of an isotope bound to functioning renal parenchyma and by planimetry of the surface area scarred, the effects of 2 organisms, a P-fimbriate Escherichia coli and an E. coli K1 have been compared. The P-fimbriate E. coli was shown to express P-fimbriae in freshly voided urine, was more hydrophobic and produced smaller scars. This indicates that neither the hydrophobicity nor P-fimbriation of the organism causing urinary tract infection (UTI) is of prime importance for the development of renal scars and is evidence against the "big bang" theory for the development of renal scars. Studies on the association of UTI with VUR showed that infection with both E. coli under study led to VUR on the side contralateral to the side undergoing surgery. It seems likely that a non-specific effect of UTI, such as bladder oedema, is responsible for this acquired VUR. An effect of the 2 bacteria under study on the lower urinary tract was observed in that infection with the P-fimbriate E. coli allowed the retention of an intravesical wax plug, whereas infection with E. coli K1 did not. Epidemiological data have shown that the majority of upper urinary tract infections in children are associated with UTI by P-fimbriate organisms. Such an association may be explained in part by an effect of P-fimbriate bacteria on lower urinary tract function rather than an effect on the upper urinary tract.

Anticholinergic versus botulinum toxin A comparison trial for the treatment of bothersome urge urinary incontinence: ABC trial.

PubMed

Visco, Anthony G; Brubaker, Linda; Richter, Holly E; Nygaard, Ingrid; Paraiso, Marie Fidela; Menefee, Shawn A; Schaffer, Joseph; Wei, John; Chai, Toby; Janz, Nancy; Spino, Cathie; Meikle, Susan

2012-01-01

This trial compares the change in urgency urinary incontinence episodes over 6 months, tolerability and cost effectiveness between women receiving daily anticholinergic therapy plus a single intra-detrusor injection of saline versus a single intra-detrusor injection of 100 U of botulinum toxin A plus daily oral placebo tablets. We present the rationale and design of a randomized-controlled trial, Anticholinergic versus Botulinum Toxin, Comparison Trial for the Treatment of Bothersome Urge Urinary Incontinence: ABC trial, conducted by the NICHD-funded Pelvic Floor Disorders Network. We discuss the innovative nature of this trial and the challenges related to choice of patient population, maintaining masking, cost effectiveness, ethical considerations, measuring adherence, and placebo development and testing. Enrollment began in April, 2010. 242 participants will be randomized and primary outcome data analysis is anticipated to begin in mid 2012. Several challenges in the trial design are discussed. Randomization to placebo intra-detrusor injections may limit recruitment, potentially impacting generalizability. Other challenges included the heavy marketing of drugs for overactive bladder which could impact recruitment of drug-naïve women. In addition, anticholinergic medications often cause dry mouth, making masking difficult. Finally, adverse reporting of transient urinary retention is challenging as there is no standardized definition; yet this is the most common adverse event following intra-detrusor botulinum toxin injection. The ABC trial will help women with urgency urinary incontinence balance efficacy, side effects and cost of anticholinergic medication versus botulinum toxin intra-detrusor injection. The results have the potential to fundamentally change the therapeutic approach to this condition. Copyright © 2011 Elsevier Inc. All rights reserved.

Effects of supplemental ruminally degradable protein versus increasing amounts of supplemental ruminally undegradable protein on nitrogen retention, apparent digestibility, and nutrient flux across visceral tissues in lambs fed low-quality forage.

PubMed

Atkinson, R L; Toone, C D; Robinson, T J; Harmon, D L; Ludden, P A

2007-12-01

Two experiments were conducted to determine effects of supplemental ruminally degradable protein (RDP) vs. increasing amounts of supplemental ruminally undegradable protein (RUP) on intake, apparent digestibility, N retention, and nutrient flux across visceral tissues in lambs fed low-quality forage. Lambs were fed a basal diet of crested wheatgrass hay (4.2% CP) for ad libitum consumption, plus 1 of 4 protein supplements: isolated soy protein (RDP source) fed to meet estimated RDP requirements (CON), or corn gluten meal (RUP source) fed at 50, 100, or 150% of the supplemental N provided by CON (C50, C100, and C150, respectively). In Exp. 1, 12 lambs (29.9 +/- 2.7 kg) were used. Forage OM intake was not affected (P = 0.46) by protein degradability or by increasing RUP (P >/= 0.31). Apparent total tract OM digestibility was not affected (P = 0.10) by protein degradability, but increased (P /= 0.40) by protein degradability or level of RUP. In Exp. 2, 16 catheterized lambs (32 +/- 5 kg) were used. Net release of ammonia-N from the portal-drained viscera (PDV) was greater (P = 0.02) for CON than for C100 and increased linearly (P = 0.002) as RUP increased. Net uptake of ammonia-N by liver was not affected (P = 0.23) by protein degradability, but increased linearly (P = 0.04) as RUP increased. Net urea-N release from liver was not affected (P >/= 0.49) by protein degradability or level of RUP. Net uptake of urea-N by PDV was greater (P = 0.02) for C100 compared with CON and increased (P = 0.04) with increasing RUP. Neither net release from PDV nor hepatic uptake of alpha-amino N were affected (P >/= 0.12) by protein degradability or level of RUP. Hepatic ammonia-N uptake accounted for 82, 38, 98, and 79% of net urea-N release from the liver for CON, C50, C100, and C150, respectively. Hepatic alpha-amino N uptake for all treatments greatly exceeded that required for the remaining urea-N release by the liver, suggesting that alpha-amino N may serve as a temporary means of storing excess N by liver between supplementation events. The pattern of net release or uptake of N metabolites between supplementation events requires further investigation.

Dynamics of the sensory response to urethral flow over multiple time scales in rat

PubMed Central

Danziger, Zachary C; Grill, Warren M

2015-01-01

The pudendal nerve carries sensory information from the urethra that controls spinal reflexes necessary to maintain continence and achieve efficient micturition. Despite the key role urethral sensory feedback plays in regulation of the lower urinary tract, there is little information about the characteristics of urethral sensory responses to physiological stimuli, and the quantitative relationship between physiological stimuli and the evoked sensory activation is unknown. Such a relation is critical to understanding the neural control of the lower urinary tract and how dysfunction arises in disease states. We systematically quantified pudendal afferent responses to fluid flow in the urethra in vivo in the rat. We characterized the sensory response across a range of stimuli, and describe a previously unreported long-term neural accommodation phenomenon. We developed and validated a compact mechanistic mathematical model capable of reproducing the pudendal sensory activity in response to arbitrary profiles of urethral flows. These results describe the properties and function of urethral afferents that are necessary to understand how sensory disruption manifests in lower urinary tract pathophysiology. Key points Sensory information from the urethra is essential to maintain continence and to achieve efficient micturition and when compromised by disease or injury can lead to substantial loss of function. Despite the key role urethral sensory information plays in the lower urinary tract, the relationship between physiological urethral stimuli, such as fluid flow, and the neural sensory response is poorly understood. This work systematically quantifies pudendal afferent responses to a range of fluid flows in the urethra in vivo and describes a previously unknown long-term neural accommodation phenomenon in these afferents. We present a compact mechanistic mathematical model that reproduces the pudendal sensory activity in response to urethral flow. These results have implications for understanding urinary tract dysfunction caused by neuropathy or nerve damage, such as urinary retention or incontinence, as well as for the development of strategies to mitigate the symptoms of these conditions. PMID:26041695

Predictors of urgency improvement after Holmium laser enucleation of the prostate in men with benign prostatic hyperplasia.

PubMed

Hur, Won Sok; Kim, Joon Chul; Kim, Hyo Sin; Koh, Jun Sung; Kim, Sang Hoon; Kim, Hyun Woo; Cho, Su Yeon; Cho, Kang Jun

2016-11-01

To investigate the change in urinary urgency and predictors of urgency improvement after holmium laser enucleation of the prostate (HoLEP) in men with benign prostatic hyperplasia (BPH). We retrospectively analyzed the medical records of patients who were treated with HoLEP for BPH and had preoperative urgency measuring ≥3 on a 5-point urinary sensation scale. Those with prostate cancer diagnosed prior to or after HoLEP, a history of other prostatic and/or urethral surgery, moderate to severe postoperative complications, and neurogenic causes were excluded. Patients who had improved urgency with antimuscarinic medication after HoLEP were excluded. We divided the patients into 2 groups based on urgency symptoms 3 months after HoLEP: improved and unimproved urgency. Improved urgency was defined as a reduction of 2 or more points on the 5-point urinary sensation scale. Preoperative clinical and urodynamic factors as well as perioperative factors were compared between groups. In total, 139 patients were included in this study. Voiding parameters in all patients improved significantly after HoLEP. Seventy-one patients (51.1%) had improved urgency, while 68 (48.9%) did not show any improvement. A history of acute urinary retention (AUR) and postvoid residual were associated with postoperative urgency improvement in univariate analysis. In multivariate analysis, a history of AUR was an independent factor affecting urgency improvement. A preoperative history of AUR could influence the change in urgency after HoLEP surgery in patients with BPH.

Rat animal model for preclinical testing of microparticle urethral bulking agents.

PubMed

Mann-Gow, Travis K; Blaivas, Jerry G; King, Benjamin J; El-Ghannam, Ahmed; Knabe, Christine; Lam, Michael K; Kida, Masatoshi; Sikavi, Cameron S; Plante, Mark K; Krhut, Jan; Zvara, Peter

2015-04-01

To develop an economic, practical and readily available animal model for preclinical testing of urethral bulking therapies, as well as to establish feasible experimental methods that allow for complete analysis of hard microparticle bulking agents. Alumina ceramic beads suspended in hyaluronic acid were injected into the proximal urethra of 15 female rats under an operating microscope. We assessed overall lower urinary tract function, bulking material intraurethral integrity and local host tissue response over time. Microphotographs were taken during injection and again 6 months postoperatively, before urethral harvest. Urinary flow rate and voiding frequency were assessed before and after injection. At 6 months, the urethra was removed and embedded in resin. Hard tissue sections were cut using a sawing microtome, and processed for histological analysis using scanning electron microscopy, light microscopy and immunohistochemistry. Microphotographs of the urethra showed complete volume retention of the bulking agent at 6 months. There was no significant difference between average urinary frequency and mean urinary flow rate at 1 and 3 months postinjection as compared with baseline. Scanning electron microscopy proved suitable for evaluation of microparticle size and integrity, as well as local tissue remodeling. Light microscopy and immunohistochemistry allowed for evaluation of an inflammatory host tissue reaction to the bulking agent. The microsurgical injection technique, in vivo physiology and novel hard tissue processing for histology, described in the present study, will allow for future comprehensive preclinical testing of urethral bulking therapy agents containing microparticles made of a hard material. © 2015 The Japanese Urological Association.

Catheter-less robotic radical prostatectomy using a custom-made synchronous anastomotic splint and vesical urinary diversion device: report of the initial series and perioperative outcomes.

PubMed

Tewari, Ashutosh; Rao, Sandhya; Mandhani, Anil

2008-09-01

To study the feasibility of avoiding a urethral catheter after robotic radical prostatectomy by using suprapubic diversion with a urethral splint, as urethral catheterization is often a source of major discomfort and pain to the patient, and can cause more concern to the patient than the procedure; we present the outcomes of a pilot study. This pilot study involved 30 patients; in group 1 (the study group of 10 patients) we used a custom-made suprapubic catheter which provided a small anastomotic splint, multiple holes for drainage and the ability to retract the splint to give a voiding trial before removing the drainage device. Group 2 was a control group of 20 patients who had standard urethral catheterization with an 18 F Silastic Foley catheter. Demographic, intraoperative and outcome data were measured and analysed. Urethral symptoms were recorded using a specially developed questionnaire. The two groups were comparable in terms of age, serum prostate specific antigen level, body mass index, Gleason scores, tumour stage, operative duration, amount of bleeding, console times, anastomotic leakage and postoperative retention rates. The study group had significantly less penile shaft or tip pain and discomfort during walking or sleeping. No patient in either group had haematuria or clot retention requiring irrigation. Urethral catheter-less robotic radical prostatectomy is feasible. The advantages are decreased penile shaft and tip pain, and decreased patient discomfort and an earlier return of continence.

5 CFR 536.301 - Mandatory pay retention.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Mandatory pay retention. 536.301 Section... PAY RETENTION Pay Retention § 536.301 Mandatory pay retention. (a) Subject to the requirements in § 536.102 and this section, an agency must provide pay retention to an employee who moves between...

Urinary and Rectal Toxicity Profiles After Permanent Iodine-125 Implant Brachytherapy in Japanese Men: Nationwide J-POPS Multi-institutional Prospective Cohort Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ohashi, Toshio, E-mail: ohashi@rad.med.keio.ac.jp; Yorozu, Atsunori; Saito, Shiro

Purpose: To assess, in a nationwide multi-institutional cohort study begun in 2005 and in which 6927 subjects were enrolled by 2010, the urinary and rectal toxicity profiles of subjects who enrolled during the first 2 years, and evaluate the toxicity profiles for permanent seed implantation (PI) and a combination therapy with PI and external beam radiation therapy (EBRT). Methods and Materials: Baseline data for 2339 subjects out of 2354 patients were available for the analyses. Toxicities were evaluated using the National Cancer Institute's Common Terminology Criteria for Adverse Events, and the International Prostate Symptom Scores were recorded prospectively until 36 months after radiationmore » therapy. Results: Grade 2+ acute urinary toxicities developed in 7.36% (172 of 2337) and grade 2+ acute rectal toxicities developed in 1.03% (24 of 2336) of the patients. Grade 2+ late urinary and rectal toxicities developed in 5.75% (133 of 2312) and 1.86% (43 of 2312) of the patients, respectively. A higher incidence of grade 2+ acute urinary toxicity occurred in the PI group than in the EBRT group (8.49% vs 3.66%; P<.01). Acute rectal toxicity outcomes were similar between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late urinary toxicities were 6.04% versus 4.82% for the PI and the EBRT groups, respectively, with no significant differences between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late rectal toxicities were 0.90% versus 5.01% (P<.01) for the PI and the EBRT groups, respectively. The mean of the postimplant International Prostate Symptom Score peaked at 3 months, but it decreased to a range that was within 2 points of the baseline score, which was observed in 1625 subjects (69.47%) at the 1-year follow-up assessment. Conclusions: The acute urinary toxicities observed were acceptable given the frequency and retention, and the late rectal toxicities were more favorable than those of other studies.« less

Putting the past behind us: Social stress-induced urinary retention can be overcome.

PubMed

Weiss, Dana A; Butler, Stephan J; Fesi, Joanna; Long, Christopher J; Valentino, Rita J; Canning, Douglas A; Zderic, Stephen A

2015-08-01

To study the pathophysiology of dysfunctional voiding, we have previously developed a model of stress-induced voiding dysfunction. We have shown that cyclosporine A (CsA), an inhibitor of the Ca(2+)-calmodulin complex, can prevent social stress-induced urinary retention. However, treatment with cyclosporine has not had an effect on the increase in the stress peptide corticotrophin-releasing factor (CRF) in Barrington's nucleus, which is involved in the micturition pathway. We now investigate whether cyclosporine administered after stress can reverse the abnormal voiding phenotype, and whether it has effects on the bladder wall itself, or on the stress response within Barrington's nucleus. Six-week old Swiss-Webster mice were exposed to aggressor males for 1 h a day, followed by 23 h of barrier separation. In a long-term trial, 1 month of stress was followed by single-cage housing for 6 months. In a separate CsA reversal trial, mice either received CsA in drinking water or had plain drinking water during 1 month of single-cage housing during recovery. Bladder contractile function was examined on a Guth myograph. Nuclear translocation of myocyte enhancing factor (MEF)-2 and NFAT (nuclear factor of activated T cells) in the bladder was assessed using electrophoretic mobility shift assays (EMSAs). The expression of CRF was determined in Barrington's nucleus using in situ hybridization. Voiding dysfunction persisted for up to 6 months after stress exposure while mice recovered in single-cage housing. In the CsA reversal trial, voiding patterns improved when they received CsA in water during single-cage housing following stress, whereas those that underwent single-cage housing alone had persistent abnormal voiding (Fig. A). There was no difference between CRF levels in Barrington's nucleus between reversal groups (p = 0.42) (Fig. B), possibly indicating a direct effect on the bladder rather than a persistent stress effect. There were no differences in the contractility of bladder wall muscle. CsA decreased the nuclear translocation of MEF-2 and NFAT induced by stress (Fig. C,D). CsA reverses stress-induced urinary retention, but does not change the stress-induced CRF increase in Barrington's nucleus. Furthermore, bladder smooth muscle contractility is unchanged by CsA; however, there are changes in the levels of the downstream transcription factors MEF-2 and NFAT. We suspect that additional CsA responsive neural changes play a pivotal role in the abnormal voiding phenotype following social stress. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Urinary incontinence following transurethral prostatectomy presenting as self inflicted penile gangrene

PubMed Central

Mukherjee, Subhabrata; Sinha, Rajan Kumar; Ghosh, Nabankur; Karmakar, Dilip

2015-01-01

An elderly diabetic man with a 67 g prostate developed a moderate degree of stress urinary incontinence along with urge urinary incontinence after transurethral resection of the prostate. Initially, he did not perform the recommended pelvic floor exercise and wrapped a rubber band around his penis to control the problem. He presented with late development of penile gangrene requiring partial amputation of his penis. The stress urinary incontinence subsided on subsequent follow-up. The patient is now doing well. PMID:26055582

Tissue engineering for urinary tract reconstruction and repair: Progress and prospect in China.

PubMed

Zou, Qingsong; Fu, Qiang

2018-04-01

Several urinary tract pathologic conditions, such as strictures, cancer, and obliterations, require reconstructive plastic surgery. Reconstruction of the urinary tract is an intractable task for urologists due to insufficient autologous tissue. Limitations of autologous tissue application prompted urologists to investigate ideal substitutes. Tissue engineering is a new direction in these cases. Advances in tissue engineering over the last 2 decades may offer alternative approaches for the urinary tract reconstruction. The main components of tissue engineering include biomaterials and cells. Biomaterials can be used with or without cultured cells. This paper focuses on cell sources, biomaterials, and existing methods of tissue engineering for urinary tract reconstruction in China. The paper also details challenges and perspectives involved in urinary tract reconstruction.

Soluble corn fiber increases bone calcium retention in postmenopausal women in a dose-dependent manner: a randomized crossover trial.

PubMed

Jakeman, Steven A; Henry, Courtney N; Martin, Berdine R; McCabe, George P; McCabe, Linda D; Jackson, George S; Peacock, Munro; Weaver, Connie M

2016-09-01

Dietary soluble corn fiber (SCF) significantly improves calcium absorption in adolescents and the bone strength and architecture in rodent models. In this study, we aimed to determine the skeletal benefits of SCF in postmenopausal women. We used our novel technology of determining bone calcium retention by following the urinary appearance of (41)Ca, a rare long-lived radioisotope, from prelabeled bone to rapidly and sensitively evaluate the effectiveness of SCF in reducing bone loss. A randomized-order, crossover, double-blinded trial was performed in 14 healthy postmenopausal women to compare doses of 0, 10, and 20 g fiber from SCF/d for 50 d. A dose-response effect was shown with 10 and 20 g fiber from SCF/d, whereby bone calcium retention was improved by 4.8% (P < 0.05) and 7% (P < 0.04), respectively. The bone turnover biomarkers N-terminal telopeptide and osteocalcin were not changed by the interventions; however, a significant increase in bone-specific alkaline phosphatase, which is a bone-formation marker, was detected between 0 and 20 g fiber from SCF/d (8%; P = 0.035). Daily SCF consumption significantly increased bone calcium retention in postmenopausal women, which improved the bone calcium balance by an estimated 50 mg/d. This study was registered at clinicaltrials.gov as NCT02416947. © 2016 American Society for Nutrition.

75 FR 13699 - Customs Broker Recordkeeping Requirements Regarding Location and Method of Record Retention

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-23

... Regarding Location and Method of Record Retention AGENCY: Customs and Border Protection, Department of... recordkeeping requirements as they pertain to the location and method of record retention. Specifically, Customs... comments, identified by USCBP docket number, by one of the following methods: Federal eRulemaking Portal...

40 CFR 80.335 - What gasoline sample retention requirements apply to refiners and importers?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 17 2013-07-01 2013-07-01 false What gasoline sample retention... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Sampling, Testing and Retention Requirements for Refiners and Importers § 80.335 What gasoline sample...

40 CFR 80.335 - What gasoline sample retention requirements apply to refiners and importers?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 16 2010-07-01 2010-07-01 false What gasoline sample retention... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Sampling, Testing and Retention Requirements for Refiners and Importers § 80.335 What gasoline sample...

40 CFR 80.335 - What gasoline sample retention requirements apply to refiners and importers?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 17 2012-07-01 2012-07-01 false What gasoline sample retention... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Sampling, Testing and Retention Requirements for Refiners and Importers § 80.335 What gasoline sample...

40 CFR 80.335 - What gasoline sample retention requirements apply to refiners and importers?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 17 2014-07-01 2014-07-01 false What gasoline sample retention... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Sampling, Testing and Retention Requirements for Refiners and Importers § 80.335 What gasoline sample...

40 CFR 80.335 - What gasoline sample retention requirements apply to refiners and importers?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 16 2011-07-01 2011-07-01 false What gasoline sample retention... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Sulfur Sampling, Testing and Retention Requirements for Refiners and Importers § 80.335 What gasoline sample...

49 CFR 172.201 - Preparation and retention of shipping papers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Preparation and retention of shipping papers. 172..., TRAINING REQUIREMENTS, AND SECURITY PLANS Shipping Papers § 172.201 Preparation and retention of shipping papers. (a) Contents. When a description of hazardous material is required to be included on a shipping...

[Investigation of urinary management after removal of indwelling urethral catheters in a general hospital: associations between bedridden state and impaired bladder emptying].

PubMed

Tsuchiyama, Katsuki; Ueki, Osamu; Minami, Hidero; Kawaguchi, Kouhei; Aoki, Yoshitaka; Yokoyama, Osamu

2010-06-01

In this study we investigated the influences of decreased levels of activities of daily living (ADL), especially in bedridden patients,on lower urinary tract dysfunction and urinary management during hospital care. All 1,106 non-urological inpatients (896 non-bedridden patients and 210 bedridden patients) with an indwelling urethral catheter treated at Noto General Hospital between April 2006 and October 2009 were retrospectively evaluated. Maximum bladder capacity and post-void residual urine volume (PVR) were evaluated with uroflowmetry or voiding cystourethrography at the time the catheter was removed. Clean intermittent catheterization (CIC) and drug administration were performed for patients who had a PVR of 100 ml or more. Bedridden patients required urinary interventions at a higher rate than did non-bedridden patients (bedridden : 29.0%,non-bedridden : 17.6%). Although indwelling urethral catheters were reinserted in 13 patients in the bedridden group and 16 patients in the non-bedridden group,many patients in both groups could be free from the catheter. Our results indicate that patients with low ADL are vulnerable to impaired bladder emptying,and early diagnosis of impaired bladder emptying and active urinary management are required to solve their urinary problems.

Cytomegalovirus peritonitis after kidney transplantation diagnosed through histopathological examination.

PubMed

Hotta, Kiyohiko; Fukasawa, Yuichiro; Wada, Yoshiki; Fukuzawa, Nobuyuki; Seki, Toshimori; Harada, Hiroshi

2017-08-01

Among organ transplant recipients, cytomegalovirus (CMV) commonly results in various types of infection such as pneumonitis, hepatitis, and enterocolitis. However, CMV peritonitis is very rare and difficult to diagnose owing to lack of visible clinical signs. We present a case of a 35-year-old female kidney recipient who developed abdominal pain and urinary retention caused by CMV peritonitis. To our knowledge, this is the first case report of CMV peritonitis after organ transplantation to be diagnosed through histopathological examination. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Radiologic-pathologic findings of solitary fibrous tumor of the prostate presenting as a large mass with delayed filling-in on MRI.

PubMed

Bhargava, Puneet; Lee, Jean Hwa; Gupta, Saurabh; Seyal, Adeel Rahim; Vakar-Lopez, Funda; Moshiri, Mariam; Dighe, Manjiri Kiran

2012-01-01

We report a case of a solitary fibrous tumor of prostate presenting with urinary retention and a large prostate mass. We describe the clinical presentation, magnetic resonance imaging findings, and histopathology of this rare, benign tumor. Although clinical and radiologic appearances embrace various differential diagnoses including sarcoma, this mass was confirmed by histologic analysis following surgical resection. We report this rare, benign tumor to help the radiologist suggest the diagnosis when presented with a similar case.

2017 European guidelines for the management of genital herpes.

PubMed

Patel, Rajul; Kennedy, Oliver J; Clarke, Emily; Geretti, Anna; Nilsen, Arvid; Lautenschlager, Stephan; Green, John; Donders, Gilbert; van der Meijden, Willem; Gomberg, Mikhail; Moi, Harald; Foley, Elizabeth

2017-12-01

Genital herpes is one of the commonest sexually transmitted infections worldwide. Using the best available evidence, this guideline recommends strategies for diagnosis, management, and follow-up of the condition as well as for minimising transmission. Early recognition and initiation of therapy is key and may reduce the duration of illness or avoid hospitalisation with complications, including urinary retention, meningism, or severe systemic illness. The guideline covers a range of common clinical scenarios, such as recurrent genital herpes, infection during pregnancy, and co-infection with human immunodeficiency virus.

Large leiomyoma of the bladder masquerading as an enlarged prostate gland.

PubMed

Itam, Sarah; Elhage, Oussama; Khan, Muhammad Shamim

2016-02-23

A 56-year-old man was admitted to hospital with shortness of breath and subsequently sustained a cardiac arrest. In the recovery period, he developed acute urinary retention and haematuria. Imaging suggested an enlarged prostate and he was started on clean intermittent catheterisation. Following further imaging and a transurethral biopsy, he was found to have a bladder leiomyoma. This was treated with laparotomy, cystotomy and enucleation of the tumour. At his 6-week follow-up appointment, he had a satisfactory cystogram and a successful void without catheter. 2016 BMJ Publishing Group Ltd.

Large leiomyoma of the bladder masquerading as an enlarged prostate gland

PubMed Central

Itam, Sarah; Elhage, Oussama; Khan, Muhammad Shamim

2016-01-01

A 56-year-old man was admitted to hospital with shortness of breath and subsequently sustained a cardiac arrest. In the recovery period, he developed acute urinary retention and haematuria. Imaging suggested an enlarged prostate and he was started on clean intermittent catheterisation. Following further imaging and a transurethral biopsy, he was found to have a bladder leiomyoma. This was treated with laparotomy, cystotomy and enucleation of the tumour. At his 6-week follow-up appointment, he had a satisfactory cystogram and a successful void without catheter. PMID:26907817

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ogawa, E.; Suzuki, S.; Tsuzuki, H.

Mice were subcutaneoulsy injected with Sr/sup 90/ or Sr/sup 85/, and effects of various drugs on their 3-day excretion and retention on the 4th day were investigated. Among chelating agents, NaCa citrate, NaMg citrate, NaSr citrate, Achromycin (or tetracycline), and aspartic MgK (alone or in combination with NH/sub 4/Cl) displayed Sr-eliminating effects. ATP increased only the excretion without diminishing the retention in bone. EDTA, DTPA, BADE, tricarballylate, Na citrate and NaPb citrate were not effective. Among salts, Mg salt, sulfite, and thiosulfate were effective in eliminating Sr. The last exerted a greater effect when given concurrently with Mg, Ca, ormore » Sr salt. Ca and Sr salt exerted no effect, and ammonium chloride promoted only urinary secretion, not extending to local or total excretion. Such salts as induce alkalosis conversely exerted inhibitory effects. Among hormones, glucocorticoids had Sreliminating effects. TSH was effective, and antithyroidal drugs conversely seemed to have excretion-diminishing effects. Among vitamins, cocarboxylase increased Sr excretion, but did not decrease the retention in bone. Also metabolic inhibitors were ineffective, and NaF conversely increased bone deposition of Sr. Among diuretics, SHdrugs, and weak chelating agents, there were no effective drugs. (JAIF)« less

Ureolytic Biomineralization Reduces Proteus mirabilis Biofilm Susceptibility to Ciprofloxacin

PubMed Central

Li, Xiaobao; Lu, Nanxi; Brady, Hannah R.

2016-01-01

Ureolytic biomineralization induced by urease-producing bacteria, particularly Proteus mirabilis, is responsible for the formation of urinary tract calculi and the encrustation of indwelling urinary catheters. Such microbial biofilms are challenging to eradicate and contribute to the persistence of catheter-associated urinary tract infections, but the mechanisms responsible for this recalcitrance remain obscure. In this study, we characterized the susceptibility of wild-type (ure+) and urease-negative (ure−) P. mirabilis biofilms to killing by ciprofloxacin. Ure+ biofilms produced fine biomineral precipitates that were homogeneously distributed within the biofilm biomass in artificial urine, while ure− biofilms did not produce biomineral deposits under identical growth conditions. Following exposure to ciprofloxacin, ure+ biofilms showed greater survival (less killing) than ure− biofilms, indicating that biomineralization protected biofilm-resident cells against the antimicrobial. To evaluate the mechanism responsible for this recalcitrance, we observed and quantified the transport of Cy5-conjugated ciprofloxacin into the biofilm by video confocal microscopy. These observations revealed that the reduced susceptibility of ure+ biofilms resulted from hindered delivery of ciprofloxacin into biomineralized regions of the biofilm. Further, biomineralization enhanced retention of viable cells on the surface following antimicrobial exposure. These findings together show that ureolytic biomineralization induced by P. mirabilis metabolism strongly regulates antimicrobial susceptibility by reducing internal solute transport and increasing biofilm stability. PMID:26953206

Analysis of urinary metanephrines by reversed-phase high-performance liquid chromatography and electrochemical detection.

PubMed

Bertani-Dziedzic, L M; Krstulovic, A M; Dziedzic, S W; Gitlow, S E; Cerqueira, S

1981-02-19

A sensitive and specific direct analysis of urinary normetanephrine (NMN) and metanephrine (MN) was achieved utilizing reversed-phase high performance liquid chromatography and electrochemical detection. Individual specimens from "control" subjects and those with pheochromocytoma were hydrolyzed and the metanephrines separated from other urinary constituents by elution with ammonia from a Dowex CG-50 resin. Chromatographic peaks were identified by retention behavior, co-chromatography with reference compounds, ratio of responses at various oxidation potentials and stopped-flow UV spectra of the collected fractions. The NMN and MN content for the control subjects was between 0.086 and 0.21 (mean - 0.14) microgram/mg creatinine and 0.012 and 0.092 (mean = 0.039) microgram/mg creatinine, respectively. The values for subjects with pheochromocytoma varied from 1.5 to 27.5 (mean = 9.9) microgram/mg creatinine for NMN and 0.10 to 1.60 (mean = 0.86) microgram/mg creatine for MN. The patient with ganglioneuroma had an NMN of 4.1 and an MN of 0.80 microgram/mg creatinine. While this method permits discrimination between those patients with pheochromocytoma and the overwhelming majority of hypertensive patients, it may ultimately be further extended to separate normal subjects from those with more subtle derangements in catecholamine metabolism.

Comparison of observed lung retention and urinary excretion of thorium workers and members of the public in India with the values predicted by the ICRP biokinetic model.

PubMed

Jaiswal, D D; Singh, I S; Nair, Suma; Dang, H S; Garg, S P; Pradhan, A S

2004-01-01

The daily intake of natural Th and its contents in lungs, skeleton and liver of an Indian adult population group were estimated using radiochemical neutron activation analysis (RNAA) technique. These data on daily intake (through inhalation and ingestion) were used to compute Th contents in lungs and other systemic organs such as skeleton and liver using the new human respiratory tract model (HRTM) and the new biokinetic model of Th. The theoretically computed Th contents in lungs, skeleton and liver of an average Indian adult are 2.56, 4.00 and 0.17 microg, respectively which are comparable with the corresponding experimentally measured values of 4.31, 3.45 and 0.14 microg in an urban population group living in Mumbai. The measured lung contents of Th in a group of five occupational workers were used to compute their total body Th contents and the corresponding daily urinary excretions. The computed total body contents and daily urinary excretions of Th in the five subjects compared favourably with their measured values. These studies, thus, validate the new biokinetic model of Th in natural as well as in occupational exposures in Indian conditions.

Community-associated urinary infections requiring hospitalization: risk factors, microbiological characteristics and patterns of antibiotic resistance.

PubMed

Medina-Polo, J; Guerrero-Ramos, F; Pérez-Cadavid, S; Arrébola-Pajares, A; Sopeña-Sutil, R; Benítez-Sala, R; Jiménez-Alcaide, E; García-González, L; Alonso-Isa, M; Lara-Isla, A; Passas-Martínez, J B; Tejido-Sánchez, Á

2015-03-01

Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective. A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed. Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2±19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + β lactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively. CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Combined electrohydraulic and holmium: YAG laser ureteroscopic nephrolithotripsy of large (>2 cm) renal calculi

PubMed Central

Mariani, Albert J.

2008-01-01

Percutaneous nephrolithotripsy (PCL) is a standard treatment for renal calculi >2 cm. Modern flexible ureteroscopes and accessories employing the complementary effects of electrohydraulic lithotripsy (EHL) and Ho:YAG laser lithotrites can treat these renal calculi in a minimally invasive fashion with similar or superior results. Objective: To assess the safety and efficacy of ureteroscopic nephrolithotripsy monotherapy for the management of >2 cm renal calculi in the community setting. Materials and Methods: Fifty nine patients with 63 renal calculi ranging from 20 to 97 mm (mean 44 mm) in length and 175 to 3300 mm2 (mean 728 mm2) area underwent staged ureteroscopic nephrolithotripsy monotherapy. Obesity (BMI > 30) was present in 54% and 19% were morbidly obese (BMI > 40). An infectious etiology was present in 49% and hard stone components in 89%. All patients presented with hematuria, pain, and/or recurrent urinary tract infection (UTI). Lithotripsy was performed with a single deflection flexible ureteroscope and predominantly EHL. Laser drilling was employed (n = 6) to weaken very hard stones prior to EHL. Low intrarenal pressure was maintained by continuous bladder drainage and placement of a stiff safety wire. Visibility was maintained using manual pulsatile irrigation. Results: All patients were rendered pain and infection-free. No patient required a blood transfusion and there was no change in serum creatinine. Mobile stone-free status was achieved in 60/63 (95%) with a mean of 1.7 nephrolithotripsy stages and 0.38 secondary or ancillary procedures. Outpatient management was sufficient for 121/131 (92%) of the procedures. Operative time averaged 46 min/stage and 79 min/calculus. Complications included endotoxic shock (3), fever (5), ureteral fragments requiring treatment (11), delayed extubation (2), delayed pneumonia (1), and urinary retention (1). Conclusion: Staged ureteroscopic nephrolithotripsy of large renal calculi is feasible with low morbidity and stone clearance rates that compare favorably with PCL. It has largely replaced PCL at this institution. PMID:19468511

49 CFR 1220.1 - Records required to be retained.

Code of Federal Regulations, 2010 CFR

2010-10-01

... required retention periods, the records may be destroyed at the discretion of each company's management. It... operational data required by the Board. The company may request a ruling from the Board on the retention of...

Bone dissemination of prostate cancer after holmium laser enucleation of the prostate: a case report and a review of the literature.

PubMed

Koguchi, Dai; Nishi, Morihiro; Satoh, Takefumi; Shitara, Toshiya; Matsumoto, Kazumasa; Fujita, Tetsuo; Yoshida, Kazunari; Iwamura, Masatsugu

2014-02-01

We report a case of dissemination of prostate cancer after holmium laser enucleation of the prostate in an 80-year-old patient. The patient presented at hospital because of nocturia. Transrectal ultrasound-guided biopsy was carried out because of high serum prostate-specific antigen (3.55 ng/mL), but it showed no malignancies. Benign prostate hyperplasia was diagnosed, and he was started on an α1-blocker. Although the urinary symptom improved with silodosin, acute urinary retention occurred 3 years after therapy began. Holmium laser enucleation of the prostate for relief of bladder outlet obstruction enabled discharge of urine. Pathological examination of the resected tissue found adenocarcinoma with a high Gleason score, 4 + 5. Serum alkaline phosphatase increased rapidly after holmium laser enucleation, and bone scintigraphy confirmed multiple bone metastases. Prostate cancer, T1bN0M1b, was diagnosed. © 2013 The Japanese Urological Association.

Testosterone and benign prostatic hyperplasia

PubMed Central

Jarvis, Thomas R; Chughtai, Bilal; Kaplan, Steven A

2015-01-01

The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms (LUTS) in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination (including history, examination and laboratory testing of testosterone) should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients. PMID:25337845

Determination of N-(trans-4-isopropylcyclohexanecarbonyl)-D-phenylalanine and its metabolites in human plasma and urine by column-switching high-performance liquid chromatography with ultraviolet detection.

PubMed

Ono, I; Matsuda, K; Kanno, S

1997-05-09

A simple, rapid and sensitive two column-switching high-performance liquid chromatographic (HPLC) method with ultraviolet detection at 210 nm has been developed for the determination of N-(trans-4-isopropylcyclohexanecarbonyl)-D-phenylalanine (AY4166, I) and its seven metabolites in human plasma and urine. Measurements of I and its metabolites were carried out by two column-switching HPLC, because metabolites were classified into two groups according to their retention times. After purification of plasma samples using solid-phase extraction and direct dilution of urinary samples, I and each metabolite were injected into HPLC. The calibration graphs for plasma and urinary samples were linear in the ranges 0.1 to 10 microg ml(-1) and 0.5 to 50 microg ml(-1), respectively. Recoveries of I and its seven metabolites were over 88% by the standard addition method and the relative standard deviations of I and its metabolites were 1-6%.

Herpes zoster-associated acute urinary retention: a case report.

PubMed

Julia, Jimmy J; Cholhan, Hilary J

2007-01-01

An 87-year-old woman presents with a 4-week history of urinary incontinence during which she had been treated for disseminated herpes zoster virus (HZV). On physical exam painful vesicles involving the entire vulvar region with mainly right sacral distribution were found. A catheterized volume exceeded 600 ml of retained urine after the patient failed to void spontaneously. Multichannel voiding-pressure urodynamic studies revealed an acontractile neurogenic bladder with overflow incontinence. The patient was discharged on a conservative regimen with arrangement for visiting nurse services to perform intermittent self-catheterization twice daily. Urodynamic testing was repeated 10 weeks after initial symptoms. During voiding cystometry a biphasic increase in detrusor pressure of 15 cm H2O was observed with no increase in abdominal pressure. The patient emptied 400 ml with a postvoid residual of 300 ml. Recovery from HZV-associated bladder emptying dysfunction can be achieved usually through conservative management, including intermittent self-catheterization. Complete recovery time ranges from 4 to 10 weeks.

Transurethral canine prostatectomy with a cylindrically diffusing fiber

NASA Astrophysics Data System (ADS)

Cromeens, Douglas M.; Johnson, Douglas E.; Price, Roger E.

1994-09-01

In this study, visual laser ablation of the prostate (VLAP) was performed on eight mongrel dogs utilizing a cylindrically diffusing fiber attached to a 1.06 neodymium:YAG (Nd:YAG) laser. All dogs received one continuous dose totaling 15,000 J (25 W for 10 min) applied from the vesical neck to the colliculus seminalis. There was no visible hemorrhage from the lasing intraoperatively in any dog. Postoperative recovery was uneventful with no dog experiencing urinary incontinence and only one incident of dysuria with urinary retention during their observation period. Gross and histopathologic examinations of serial sections of the prostate were performed from 2 hours to 7 weeks postoperatively and demonstrated a consistent spherical zone of destruction 2.9 cm (average) in diameter. We believe the simplified fiber placement and complete lack of postoperative complications in this small group of dogs suggest that the cylindrically diffusing fiber offers significant advantage over laterally deflecting fibers for transurethral prostatectomies in the dog.

Dysuria due to discospondylitis and intervertebral disc herniation in a male alpaca (Vicugna pacos).

PubMed

Sickinger, Marlene; Hirz, Manuela; Schmidt, Martin J; Reinacher, Manfred

2016-05-31

Dysuria in camelids is usually associated with the presence of lower urinary tract disease such as urolithiasis. As another differential diagnosis, urine retention may be caused by neurological disturbances resulting from infections of the spinal cord, discospondylitis or trauma. A 2.5-year-old male Huacaya alpaca (Vicugna pacos) presented with dysuria due to damage of the lumbosacral intumescence of the spinal cord. On presentation the alpaca was recumbent. Clinical examination revealed abdominal pain, oliguria, leucopenia with neutrophilia, and slightly elevated creatinine kinase. Ultrasonography of the abdomen showed an irregularly shaped, dilated urinary bladder with hyperechoic serosa. Magnetic resonance imaging revealed discospondylitis of the fourth and fifth lumbar vertebrae and herniation of the intervertebral disc between these vertebrae and the spinal cord. Postmortem examination confirmed severe chronic purulent discospondylitis with ventral spondylosis and narrowing of the spinal canal. Urolithiasis could not be verified. Although rare, diseases of the spinal cord should be considered as a differential diagnosis for impaired micturition in camelids.

Bilateral epididymal sperm granulomas following urethrostomy in a German shepherd dog.

PubMed

Batista-Arteaga, M; Santana, M; Lozano, O; Niño, T; Alamo, D; Rodríguez, F

2011-08-01

Bilateral enlargement of both epididymes was observed in a 6-year-old German shepherd dog following a pre-scrotal urethrostomy. Testicular parenchyma showed regular structure, and the spermatogenesis and the steroidogenic functions were not modified. However, macroscopic examination of the tail and the body of both epididymes exhibited multiple white and well-delimited foci. Histopathological study of the epididymes confirmed the development of granulomas associated with extravasated spermatozoa. Urethrostomy caused a severe stenosis of the penile urethra, favouring the retention of urine at the urinary bladder. The retrograde pressure exerted by the distension of the urinary bladder could have allowed the urine to reach the prostatic urethra and the deferent ducts and, finally, the epididymes, causing irritation and rupture of the mucous layer of the epididymal duct, the consequent sperm extravasation and the development of sperm granulomas. We speculate that the inadequate surgical resolution of the urethral calculi caused the bladder distension, the subsequent retrograde flow of urine and the development of the lesions. © 2010 Blackwell Verlag GmbH.

Prostate Artery Embolization for Complete Urinary Outflow Obstruction Due to Benign Prostatic Hypertrophy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yu, Simon Chun Ho, E-mail: simonyu@cuhk.edu.hk; Cho, Carmen Chi Min; Hung, Esther Hiu Yee

BackgroundWe aimed to evaluate the effectiveness of PAE in weaning of catheter and relieving obstructive urinary symptoms in patients with acute urinary retention (AUR) due to benign prostatic hypertrophy (BPH) and failed trial without catheter (TWOC).Materials and MethodsIn this prospective study approved by the institutional review board, a signed informed consent was obtained. Eighteen consecutive patients with AUR due to BPH and failed TWOC were recruited. Nineteen consecutive patients with BPH but without AUR were recruited as a control. Patients with CTA evidence of arterial occlusion or significant stenosis along the prostate artery access path were excluded. PAE was performedmore » using microspheres (100–300 μm diameter). Outcome assessment included successful weaning of catheter in 2 weeks, procedure-related complications, change of symptomatology and urodynamic findings at 1 month as compared to baseline, percent non-perfused prostate volume, and prostate volume reduction on MRI at 2 weeks.ResultsTwo patients in the study group and four in the control group were excluded due to arterial pathology. Embolization of bilateral prostate arteries was achieved in all patients in both the groups (100%). There was no complication. The catheter was successfully weaned in 87.5% (14/16) of patients within 14 days in the treatment group. There was no significant difference in patient demographics, prostate characteristics, and all outcome assessment parameters between both the groups.ConclusionsPAE was probably safe and effective in weaning of catheter and relieving obstructive urinary symptoms in patients due to BPH, with treatment outcomes comparable to those without AUR.« less

31 CFR 1010.430 - Nature of records and retention period.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Nature of records and retention period... Required To Be Maintained § 1010.430 Nature of records and retention period. (a) Wherever it is required... such a way as to be accessible within a reasonable period of time, taking into consideration the nature...

31 CFR 1010.430 - Nature of records and retention period.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Nature of records and retention period... Required To Be Maintained § 1010.430 Nature of records and retention period. (a) Wherever it is required... such a way as to be accessible within a reasonable period of time, taking into consideration the nature...

31 CFR 1010.430 - Nature of records and retention period.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Nature of records and retention period... Required To Be Maintained § 1010.430 Nature of records and retention period. (a) Wherever it is required... such a way as to be accessible within a reasonable period of time, taking into consideration the nature...

31 CFR 1010.430 - Nature of records and retention period.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Nature of records and retention period... Required To Be Maintained § 1010.430 Nature of records and retention period. (a) Wherever it is required... such a way as to be accessible within a reasonable period of time, taking into consideration the nature...

Proteus mirabilis fimbriae- and urease-dependent clusters assemble in an extracellular niche to initiate bladder stone formation.

PubMed

Schaffer, Jessica N; Norsworthy, Allison N; Sun, Tung-Tien; Pearson, Melanie M

2016-04-19

The catheter-associated uropathogenProteus mirabilisfrequently causes urinary stones, but little has been known about the initial stages of bladder colonization and stone formation. We found thatP. mirabilisrapidly invades the bladder urothelium, but generally fails to establish an intracellular niche. Instead, it forms extracellular clusters in the bladder lumen, which form foci of mineral deposition consistent with development of urinary stones. These clusters elicit a robust neutrophil response, and we present evidence of neutrophil extracellular trap generation during experimental urinary tract infection. We identified two virulence factors required for cluster development: urease, which is required for urolithiasis, and mannose-resistantProteus-like fimbriae. The extracellular cluster formation byP. mirabilisstands in direct contrast to uropathogenicEscherichia coli, which readily formed intracellular bacterial communities but not luminal clusters or urinary stones. We propose that extracellular clusters are a key mechanism ofP. mirabilissurvival and virulence in the bladder.

Spinal instrumentation for Duchenne's muscular dystrophy: experience of hypotensive anaesthesia to minimise blood loss.

PubMed

Fox, H J; Thomas, C H; Thompson, A G

1997-01-01

Nineteen patients with Duchenne's muscular dystrophy underwent segmental spinal instrumentation and posterior fusion between 1989 and 1994. The indication for surgery was loss of the ability to walk and development of scoliosis with sitting discomfort. Preoperative assessment included evaluation of pulmonary function. Average age at operation was 12.5 years. Instrumentation and fusion extended from upper thoracic levels to L-5 or the sacrum. A Hartshill rectangle was used in all cases, with banked allograft bone. Severe intraoperative blood loss was avoided by use of hypotensive anaesthesia. Peroperatively, systolic blood pressure was maintained between 75 and 85 mm Hg. Average blood loss was 1,246 ml (range, 400-3,100) or 30% of estimated total blood volume. Average transfusion requirements were 3 units of packed cells. Postoperative analgesia was provided by infusion via an epidural catheter. There were no postoperative wound or chest infections. Three patients required catheterisation for urinary retention. Postoperatively patients were fitted with a Neofract jacket to allow early mobilisation and discharge. Mean postoperative length of stay was 16 days. Posterior spinal fusion by using the Hartshill rectangle provided good correction and fixation. Hypotensive anaesthesia permitted surgery to be performed rapidly in a relatively dry field and avoided the complications of severe intraoperative blood loss and massive transfusion.

Anorectal emergencies.

PubMed

Lohsiriwat, Varut

2016-07-14

Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.

Biodegradable braided poly(lactic-co-glycolic acid) urethral stent combined with dutasteride in the treatment of acute urinary retention due to benign prostatic enlargement: a pilot study.

PubMed

Kotsar, Andres; Isotalo, Taina; Juuti, Hanne; Mikkonen, Joonas; Leppiniemi, Jenni; Hänninen, Venla; Kellomäki, Minna; Talja, Martti; Tammela, Teuvo L J

2009-03-01

To evaluate, in a pilot study, the efficacy and safety of combining a braided poly(lactic-co-glycolic acid) (PLGA, a copolymer of l-lactide and glycolide) urethral stent and dutasteride in the treatment of acute urinary retention (AUR) due to benign prostatic enlargement (BPE). Ten men with AUR due to BPE were treated as outpatients. A biodegradable braided PLGA urethral stent was inserted into the prostatic urethra, using a specially designed insertion device under visual control. Dutasteride treatment was started and the patients were followed up for 3 months after insertion of the stents. In all patients the stents were placed successfully with the new insertion device. All men were able to void after inserting the stent. At 1 month five patients voided freely with a low residual urine volume (<150 mL), two voided but had a high residual urine volume and a suprapubic catheter was placed, and three needed a suprapubic or an indwelling catheter before 1 month, due to AUR or comorbidities. At 3 months five patients were voiding with no problems. We have developed a new and effective insertion device for biodegradable braided prostatic stents. The new braided-pattern stent overcomes the earlier problems of migration and sudden breakage into large particles associated with biodegradable spiral stents. However, the mechanical properties of the new stent need to be improved and tested in a longer follow-up. We consider that this new biodegradable braided-pattern urethral stent could provide a new option in the future treatment of AUR.

Urolume stent placement for the treatment of postbrachytherapy bladder outlet obstruction.

PubMed

Konety, B R; Phelan, M W; O'Donnell, W F; Antiles, L; Chancellor, M B

2000-05-01

Transurethral resection (TURP) or incision of the prostate is generally not effective for treating bladder outlet obstruction after transperineal brachytherapy for prostate cancer. Furthermore, TURP could compromise full-dose effective radiation delivery to the prostate. We analyzed the efficacy of the UroLume stent in treating the urinary outflow obstruction in such patients. Five patients who had undergone brachytherapy (3 with (192)Ir high-dose radiation and 2 with (125)I) subsequently developed one or more episodes of urinary retention 2 weeks to 4 years after treatment. The patients failed or could not tolerate alpha-blockers or clean intermittent catheterization. Three patients subsequently underwent urethral dilation/optical internal urethrotomy for strictures, and 1 patient underwent suprapubic tube placement. Following the failure of these interventions, each of these patients had a UroLume stent placement. A single UroLume stent (2 cm in 3 patients and 2.5 cm in 2 patients) was placed under local/spinal anesthesia. All patients were able to void spontaneously immediately after stent placement. Of the patients with previous urethral strictures, 1 remained continent and 1 had persistent incontinence. Neither of the patients with early postbrachytherapy retention developed incontinence after stent placement. The main complaints following stent placement were referred pain to the head of the penis and dysuria. Stent-related symptoms necessitated stent removal in 2 of 5 patients, 4 to 6 weeks after placement. The UroLume stent can be used as an alternative form of therapy for managing postbrachytherapy bladder outlet obstruction. The treatment is easily reversible by removing the stent when obstruction resolves.

[Immediate fetal-maternal morbidity of first instrumental vaginal delivery using Thierry's spatulas. A prospective continuous study of 195 fetal extractions].

PubMed

Parant, O; Simon-Toulza, C; Capdet, J; Fuzier, V; Arnaud, C; Rème, J-M

2009-10-01

To investigate the immediate fetal-maternal morbidity related to Thierry's spatula for first instrumental vaginal delivery. We conducted a prospective observational study in Toulouse university hospital, including primiparas who vaginally delivered a live singleton cephalic infant>36 WG, between December 2005 and June 2006. Instrumental deliveries were performed using short spatulas in all cases. Outcome measures were: perineal complications (episiotomy, laceration and associated lesions, urinary retention, pain at H48), neonatal morbidity (cutaneous injuries, neonatal transfer, cord pH, Apgar score). Instrumental deliveries were compared with spontaneous vaginal deliveries (SVD). Six hundred and eight primiparas were included, distributed in 195 extractions (32%) and 413 SVD (68%). Spatulas allowed fetal extraction in all cases. Main differences between the two groups were: length of labour, occiput posterior position (12.8% for spatulas vs 1.7% for SVD; p<0.0001), episiotomy rate (97.9% vs 51.3%; p<0.0001), severe perineal lacerations (3.6% vs 0.2%; p=0.0007), post-partum morbidity (pain, hematoma, and urinary retention). No case of early severe neonatal complication was related to the use of the spatulas. Perineal complications (severe lacerations) associated with spatulas are increased with regard to SVD, but comparable to that reported with forceps. The main disadvantage is the high frequency of episiotomy, which should not be systematic. Neonatal morbidity is reduced. Comparative studies (spatulas vs. other procedures) are needed to confirm these data, but spatulas remain a multipurpose instrument which should continue to be taught.

[Approach and complications associated with suburethral synthetic slings in women: Systematic review and meta-analysis].

PubMed

Biardeau, X; Zanaty, M; Aoun, F; Benbouzid, S; Peyronnet, B

2016-03-01

We aim to assess the complications associated with different approaches used in female suburethral sling surgery. We performed a research on Medline using the following keywords: "suburethral slings", "complications", "safety" and "randomized". Only randomized clinical trials including women and reporting intra- and postoperative complications associated with the retropubic (RP) approach; TOT and/or TVT-O were included. The meta-analysis was conducted using the Review Manager (RevMan 5.3) software delivered by the "Cochrane Library". Out of 176 articles, 23 were included in synthesis. Risks of bladder perforation during surgery (60/1482 vs 5/1479; OR=6.44; 95% CI [3.32-12.50]) and postoperative urinary retention (48/1160 vs 24/1159; OR=1.93; 95% CI [1.26-3.12]) were significantly higher with the RP approach, when compared with the transobturator (TO) approach (TOT or TVT-O). Conversely, the risk of prolonged postoperative pain was significantly lower after RP approach, when compared with TO approach (24/1156 vs 69/1149; OR=0.36; 95% CI [0.23-0.56]). Risks of intraoperative urethral injury, postoperative erosion and de novo overactive bladder were comparable between the two approaches. Data regarding the comparison between TOT and TVT-O were scarce and did not allow us to conclude about complications associated with. The RP approach was associated with a significant risk of bladder perforation and postoperative urinary retention. The TO approach was associated with a higher risk of prolonged postoperative pain. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Long-term follow-up of sacral neuromodulation for lower urinary tract dysfunction.

PubMed

Peeters, Karlien; Sahai, Arun; De Ridder, Dirk; Van Der Aa, Frank

2014-05-01

To report our long-term experience of sacral neuromodulation (SNM) for various lower urinary tract dysfunctions but with a focus on efficacy, safety, re-interventions and degree of success. This is a single tertiary referral centre study that included 217 patients (86% female) who received an implantable pulse generator (IPG) (Interstim™, Medtronic, Minneapolis, USA) between 1996 and 2010. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline, but was further stratified. The mean duration of follow-up was 46.88 months. Success and cure rates were ≈70% and 20% for urgency incontinence, 68% and 33% for urgency frequency syndrome and 73% and 58% for idiopathic retention. In those patients with an unsuccessful therapy outcome, the mean time to failure was 24.6 months after implantation. There were 88 (41%) patients who had at least one device or treatment related surgical re-intervention. The re-intervention rate was 1.7 per patient with most of them (47%) occurring ≤2 years of follow-up. SNM appears effective in the long-term with a success rate after definitive IPG implant of ≈70% and complete cure rates ranging between 20% and 58% depending on indication. Patients with idiopathic retention appear to do best. The re-intervention rate is high with most occurring ≤2 years of implantation. It is likely that with the newer techniques used, efficacy and re-intervention rates will improve. © 2013 The Authors. BJU International © 2013 BJU International.

Protective Effect of Aronia Melanocarpa Polyphenols on Cadmium Accumulation in the Body: A Study in a Rat Model of Human Exposure to this Metal.

PubMed

Brzoska, Malgorzata M; Galazyn-Sidorczuk, Malgorzata; Jurczuk, Maria; Tomczyk, Michal

2015-01-01

Recently a growing attention has been paid to the possibility of using biologically active compounds, including polyphenols, for the prevention of unfavourable effects of exposure to xenobiotics. The study was aimed to investigate, in a female rat model, whether consumption of Aronia melanocarpa polyphenols (AMP) under chronic exposure to cadmium (Cd) decreases the gastrointestinal absorption and body burden of this heavy metal. For this purpose, Cd turnover (apparent absorption, retention in the body, concentration in the blood, soft tissues and bone tissue, total pool in internal organs, faecal and urinary excretion) was evaluated in the female Wistar rats who were administered only a 0.1% aqueous extract of AMP (prepared from the powdered extract containing 65.74% of polyphenols) as drinking fluid or/and Cd in diet (1 and 5 mg/kg) for up to 24 months. AMP administration under the low Cd treatment (1 mg/kg diet) had only a very slight protective impact against this metal accumulation in the organism, whereas polyphenols application under moderate exposure (5 mg Cd/kg diet) significantly decreased apparent absorption and retention in the body, and increased urinary concentration of this xenobiotic, resulting in its lower concentration in the blood and lower accumulation in soft tissues (mainly in the liver and kidneys) and bone tissue. Based on the study, it can be concluded that consumption of polyphenol- rich products may prevent Cd absorption from the diet polluted by this metal and its accumulation in the females' body, and thus also prevent its toxic action.

Laparoscopic extraperitoneal inguinal hernia repair. A safe approach based on the understanding of rectus sheath anatomy.

PubMed

Katkhouda, N; Campos, G M; Mavor, E; Trussler, A; Khalil, M; Stoppa, R

1999-12-01

We have devised a reproducible approach to the preperitoneal space for laparoscopic repair of inguinal hernias that is based on an understanding of the abdominal wall anatomy. Laparoscopic totally extraperitoneal herniorrhaphy was performed on 99 hernias in 90 patients at the Los Angeles County-University of Southern California Medical Center, using a standardized approach to the preperitoneal space. Operative times, morbidity, and recurrence rates were recorded prospectively. The median operative time was 37 min (range, 28-60) for unilateral hernias and 46 min (range, 35-73) for bilateral hernias. There were no conversions to open repair, and there was only one conversion to a laparoscopic transabdominal approach. Complications were limited to urinary retention in two patients, pneumoscrotum in one patient, and postoperative pain requiring a large dose of analgesics in one patient. All patients were discharged within 23 h. There were no recurrences or neuralgias on follow-up at 2 years. A standardized approach to the preperitoneal space based on a thorough understanding of the abdominal wall anatomy is essential to a satisfactory outcome in hernia repair.

[Characteristic Features of Urinary Incontinence--Diagnostic Investigation in Geriatric Patients].

PubMed

Kirschner-Hermanns, R; Anding, R

2016-02-01

Urinary incontinence is a common medical and social problem in elderly people. It leads to a massive reduction in the quality of life of affected persons and their dependants and causes an enormous socio-economic burden, which will increase significantly within the next years and decades as the age structure of the German population changes. Successful treatment of urinary incontinence in the elderly requires a good pathophysiological understanding of the underlying problem as well as individually tailored diagnostic procedures, which must be oriented at the patient's wishes, the social environment and the resulting therapeutic consequences. This especially applies to persons with symptoms of dementia. Comorbidities such as diabetes mellitus, reduced mobility and a medication-induced decrease in cognitive function play a major role in the severity of urgency and urinary incontinence in the elderly. Also the frequently described concomitant diagnosis of urinary tract infection must be exactly evaluated. Before antibiotic treatment is given, it should be clarified if the patient suffers from "harmless" bacteriuria or a urinary tract infection requiring treatment. Patients with an age-associated decrease in brain power must be diagnosed quite carefully, because these patients may potentially be harmed by pharmacological treatment for overactive bladder syndrome. © Georg Thieme Verlag KG Stuttgart · New York.

Prognostic Value of Ultrasound Grading Systems in Prenatally Diagnosed Unilateral Urinary Tract Dilatation.

PubMed

Scalabre, Aurélien; Demède, Delphine; Gaillard, Ségolène; Pracros, Jean-Pierre; Mouriquand, Pierre; Mure, Pierre-Yves

2017-04-01

We compared the prognostic value of anteroposterior intrasinus diameter of the renal pelvis, urinary tract dilatation and the Society for Fetal Urology grading system in children with prenatally diagnosed unilateral urinary tract dilatation. All newborns with prenatally diagnosed unilateral urinary tract dilatation, normal bladder and anteroposterior intrasinus diameter 10 mm or greater on the first postnatal ultrasonography were prospectively enrolled from January 2011 to February 2015. Indications for surgery were recurrent febrile urinary tract infections and/or decrease of relative renal function more than 10% on serial isotope studies and/or increasing anteroposterior intrasinus diameter greater than 20% on serial ultrasounds. Sensitivity, specificity and ROC curves were calculated to evaluate the accuracy of anteroposterior intrasinus diameter, urinary tract dilatation and Society for Fetal Urology grading system in determining which children would need surgery within 24 months. A total of 57 males and 13 females were included. Of the patients 33 required surgery at a median age of 5 months (IQR 3.8 to 6.4). Urinary tract dilatation remained stable in 14 cases and decreased in 23 with a median followup of 42 months (IQR 25 to 67). Anteroposterior intrasinus diameter, urinary tract dilatation and Society for Fetal Urology scores were all correlated with the need for surgery. Anteroposterior intrasinus diameter with a threshold of 20 mm had the best prognostic value, with a sensitivity of 81.8% and a specificity of 91.7%. Our study confirms that the prognostic value was comparable between anteroposterior intrasinus diameter of the renal pelvis, urinary tract dilatation and Society for Fetal Urology grading system in newborns with prenatally diagnosed unilateral urinary tract dilatation. Anteroposterior intrasinus diameter and abnormal parenchymal thickness are the most important ultrasound criteria to identify children at risk for requiring surgery. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Orthotopic neo- bladder in women.

PubMed

Schettini, Manlio

2010-12-01

Radical cystectomy is the most effective treatment madality for high grade urinary bladder carcinoma and orthotopic reconstruction is the better urinary diversion modality also in women. From 2002 to 2007 we performed 14 radical cystectomies followed by orthotopic reconstruction in women aged between 47 and 68 years (mean age 56) affected by urinary bladder carcinoma. Our reconstructive technique requires the preparation of two strips of the recti muscles fascia, the sectioning of the bladder neck and, when the uterus is present, hysteroannessiectomy and cystectomy en block leaving intact the lateral and inferior vaginal walls. The pelvic floor is stabilized by a colposacropexis with a prosthesis and placing an omental flap over the prosthesis. The orthotopic reconstruction is achieved via a neobladder according to the Padovana technique. The ureters are anastomized to the neobladder and splinted with single J stents. The pathological examination demonstrated in all patients the presence of a high grade carcinoma (G3): more specifically 4 patients had a full thickness intramural infiltration (T2), 2 patients had involvment of the perivescical fat (T3) ad 8 patients were in T1 stage. Lymphnodes were negative for tumour (NO). In 8 patients blood transfusions were necessary to treat post surgical anemia. No significant intra-, peri- or post operative complications were noted. The mean follow-up was 45 months: a patient died for diffuse metastatic disease after 11 months. The remaining patients are still alive and report normal lifestyle: 10 with normal micturition and 4 with urinary retention treated with intermittent self-catetherization. Two patients report nocturnal incontinence treated with hourly micturition and one pad. The five patients who had normal preoperative sexual intercourse resumed a normal sexual activity. The possibility to orthotopically recontruct the female urinary bladder has been established long time after the introduction of orthotopic neobladder in males, when became obvious that bladder reconstruction had to be done in conjunction with the reconstruction of the pelvic floor, in order to assure a satisfactory function at the new bladder. To avoid a posterior slippage of the vaginal stump we inserted the vaginal stump into a prolene tube which was then anchored posteriorly to the sacral periostium. We covered the prolene net with a flap of omentum pedicled down from the transverse colon and brought into the pelvis through the right colic space. This solid, stable and well protected support was able to accept the new bladder. We use the Padovana technique to facilitate the anastomosis of the bladder neck to the urethra. In the patients affected by urethral ipermotility we shaped a sub urethral sling using the recti muscles fascia pedicled by the pyramidal muscles. With this modality of reconstruction female pelvic anatomy is preserved as demonstrated by recovery of sexual activity.

[Bacteriuria and Symptomatic Urinary Tract Infections during Antimicrobial Prophylaxis in Patients with Short-Term Urinary Catheters - Prospective Randomised Study in Patients after Joint Replacement Surgery].

PubMed

Dejmek, M; Kučera, T; Ryšková, L; Čermáková, E; Šponer, P

2017-01-01

PURPOSE OF THE STUDY A very serious complication following joint replacement surgery is periprosthetic joint infection that can be caused by a urinary tract infection. Insertion of an indwelling urinary catheter constitutes a risk factor that may result in urinary tract infections. The aim of this prospective randomised study was to compare the occurrence of significant bacteriuria and symptomatic urinary tract infections during antibiotic prophylaxis at the time of removal of an indwelling urinary catheter by cotrimoxazole in two doses and with no administration of antibiotics. We also monitored the incidence of potential periprosthetic infection following the endoprosthesis implantation. The findings of preoperative urine tests were compared with the declared negative preoperative examination. MATERIAL AND METHODS The study included patients indicated for a total hip or knee replacement with a negative urine culture as a part of the preoperative testing. Where leukocyteria was detected, urine culture by mid-stream clean catch urine was obtained. The second part included patients, in whom an indwelling urinary catheter had to be inserted postoperatively for urine retention and/or monitoring of fluid balance and who were divided into two groups on a rota basis. No antibiotics were administered to the first group, whereas Cotrimoxazol 960 mg tablets p.o. was administered to the second group, 14 and 2 hours before the removal of the catheter. The urine culture test was performed 4 hours after the removal of the indwelling urinary catheter, in both the groups. The test was repeated after 14 days and a questionnaire was filled in to report urinary tract complications. Considered as significant bacteriuria by urinalysis was the laboratory finding of > 10x4 CFU/ml in case of a single pathogen or > 10x5 in case of multiple pathogens. The results were statistically processed by Fischer's exact test with the level of significance = 0.05. RESULTS In the first part of the study leukocyturia was detected by a test strip in 112 of the total of 478 patients. In 10 women, significant bacteriuria was found. Altogether 50 women and 50 men were randomly assigned to the second part of the study. The indwelling urinary catheter was in place for 4 days on average. In men, no statistically significant difference was detected in significant bacteriuria findings, in women a statistically significant difference of p = 0.00162 was found after the removal and after 14 days the borderline of statistical significance of p = 0.0507 was achieved, but no symptomatic urinary tract infection was present. In the period from 20 to 32 months following the total joint replacement, no periprosthetic infection caused by urinary tract infection was reported. DISCUSSION There is enough evidence to prove the correlation between the symptomatic urinary tract infection and periprosthetic infection. On the other hand, asymptomatic bacteriuria is a common finding in patients before the planned hip of knee joint replacement and its treatment is not recommended. No consensus has been achieved as yet regarding the method of antibiotic prophylaxis for an inserted urinary catheter. Antibiotics are administered throughout the period of catheterisation by an indwelling urinary catheter, during its removal, or are not administered at all. In our study antibiotics were administered during the removal of an indwelling urinary catheter and a statistically significant difference was found in women. It concerned, however, only a higher incidence of asymptomatic bacteriuria not treated by antibiotics, which in the next follow-up period did not lead to periprosthetic infection. CONCLUSIONS Despite the negative pre-operative urine culture, frequent incidence of leukocyturia and symptomatic urinary infections were detected in a fairly high number of cases. Therefore, we recommend asking the patients during the hospital admission process specifically about the urinary infection symptoms. The results of our study show that antibiotic prophylaxis during the removal of indwelling urinary catheters placed for a short-term is unnecessary. Key words: endoprosthesis, urinary catheter, bacteriuria, urinary tract infection.

Critical appraisal of the Spanner™ prostatic stent in the treatment of prostatic obstruction

PubMed Central

McKenzie, Patrick; Badlani, Gopal

2011-01-01

The Spanner™ stent was first used in patients to relieve bladder outlet obstruction (BOO), and has recently been used in patients following transurethral microwave thermotherapy and men unfit for surgical intervention. We review the current literature on the role of the Spanner stent in treating prostatic obstruction compared to previously reported cases involving the use of temporary stents. The Spanner stent has been found to be successful in treating patients with bladder outlet obstruction from benign prostatic hyperplasia and following high-energy transurethral microwave thermotherapy (TUMT). Patients with the Spanner stent had an increase in peak flow rate and a decrease in post void residual and International Prostate Symptom Scores. In patients treated with TUMT, quality of life measures indicate that the Spanner stent shows increased ease of bladder drainage, decreased leakage, and no adverse effect on daily activities. In patients unfit for surgery, however, there was increased retention and pain requiring stent removal in 63% of cases. The Spanner stent offers ease of insertion with a decrease in voiding symptoms in selected patients. Based on limited data, the Spanner stent has been recommended as a treatment option for men with BOO following TUMT. However, it is not a good treatment option for men unfit for surgery based on an increased incidence of urinary retention and dysuria. The Spanner stent is the only currently approved temporary stent and, based on a literature review, it does not offer significant advantage over previously used temporary stents. It is notable that most researchers have not evaluated the role of detrusor function on the outcomes. PMID:22915927

Urinary Tract Infections in the Older Adult.

PubMed

Nicolle, Lindsay E

2016-08-01

Urinary infection is the most common bacterial infection in elderly populations. The high prevalence of asymptomatic bacteriuria in both men and women is benign and should not be treated. A diagnosis of symptomatic infection for elderly residents of long-term care facilities without catheters requires localizing genitourinary findings. Symptomatic urinary infection is overdiagnosed in elderly bacteriuric persons with nonlocalizing clinical presentations, with substantial inappropriate antimicrobial use. Residents with chronic indwelling catheters experience increased morbidity from urinary tract infection. Antimicrobial therapy is selected based on clinical presentation, patient tolerance, and urine culture results. Copyright © 2016 Elsevier Inc. All rights reserved.

Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method.

PubMed

Lefrant, J-Y; Muller, L; de La Coussaye, J Emmanuel; Benbabaali, M; Lebris, C; Zeitoun, N; Mari, C; Saïssi, G; Ripart, J; Eledjam, J-J

2003-03-01

Comparisons of urinary bladder, oesophageal, rectal, axillary, and inguinal temperatures versus pulmonary artery temperature. Prospective cohort study. Intensive Care Unit of a University-Hospital. Forty-two intensive care patients requiring a pulmonary artery catheter (PAC). Patients requiring PAC and without oesophageal, urinary bladder, and/or rectal disease or recent surgery were included in the study. Temperature was simultaneously monitored with PAC, urinary, oesophageal, and rectal electronic thermometers and with axillary and inguinal gallium-in-glass thermometers. Comparisons used a Bland and Altman method. The pulmonary arterial temperature ranged from 33.7 degrees C to 40.2 degrees C. Urinary bladder temperature was assessed in the last 22 patients. A total of 529 temperature measurement comparisons were carried out (252 comparisons of esophageal, rectal, inguinal, axillary, and pulmonary artery temperature measurements in the first 20 patients, and 277 comparisons with overall methods in the last patients). Nine to 18 temperature measurement comparisons were carried out per patient (median = 13). The mean differences between pulmonary artery temperatures and those of the different methods studied were: oesophageal (0.11+/-0.30 degrees C), rectal (-0.07+/-0.40 degrees C), axillary (0.27+/-0.45 degrees C), inguinal (0.17+/-0.48 degrees C), urinary bladder (-0.21+/-0.20 degrees C). In critically ill patients, urinary bladder and oesophageal electronic thermometers are more reliable than the electronic rectal thermometer which is better than inguinal and axillary gallium-in-glass thermometers to measure core temperature.

Macrophages as key elements of Mixed-oxide [U-Pu(O2)] distribution and pulmonary damage after inhalation?

PubMed

Van der Meeren, Anne; Moureau, Agnes; Griffiths, Nina M

2014-11-01

Abstract Purpose: To investigate the consequences of alveolar macrophage (AM) depletion on Mixed OXide fuel (MOX: U, Pu oxide) distribution and clearance, as well as lung damage following MOX inhalation. Rats were exposed to MOX by nose only inhalation. AM were depleted with intratracheal administration of liposomal clodronate at 6 weeks. Lung changes, macrophage activation, as well as local and systemic actinide distribution were studied up to 3 months post-inhalation. Clodronate administration modified excretion/retention patterns of α activity. At 3 months post-inhalation lung retention was higher in clodronate-treated rats compared to Phosphate Buffered Saline (PBS)-treated rats, and AM-associated α activity was also increased. Retention in liver was higher in clodronate-treated rats and fecal and urinary excretions were lower. Three months after inhalation, rats exhibited lung fibrotic lesions and alveolitis, with no marked differences between the two groups. Foamy macrophages of M2 subtype [inducible Nitric Oxide Synthase (iNOS) negative but galectin-3 positive] were frequently observed, in correlation with the accumulation of MOX particles. AM from all MOX-exposed rats showed increased chemokine levels as compared to sham controls. Despite the transient reduced AM numbers in clodronate-treated animals no major differences on lung damage were observed as compared to non-treated rats after MOX inhalation. The higher lung activity retention in rats receiving clodronate seems to be part of a general inflammatory response and needs further investigation.

Sensory feedback from the urethra evokes state-dependent lower urinary tract reflexes in rat.

PubMed

Danziger, Zachary C; Grill, Warren M

2017-08-15

The lower urinary tract is regulated by reflexes responsible for maintaining continence and producing efficient voiding. It is unclear how sensory information from the bladder and urethra engages differential, state-dependent reflexes to either maintain continence or promote voiding. Using a new in vivo experimental approach, we quantified how sensory information from the bladder and urethra are integrated to switch reflex responses to urethral sensory feedback from maintaining continence to producing voiding. The results demonstrate how sensory information regulates state-dependent reflexes in the lower urinary tract and contribute to our understanding of the pathophysiology of urinary retention and incontinence where sensory feedback may engage these reflexes inappropriately. Lower urinary tract reflexes are mediated by peripheral afferents from the bladder (primarily in the pelvic nerve) and the urethra (in the pudendal and pelvic nerves) to maintain continence or initiate micturition. If fluid enters the urethra at low bladder volumes, reflexes relax the bladder and evoke external urethral sphincter (EUS) contraction (guarding reflex) to maintain continence. Conversely, urethral flow at high bladder volumes, excites the bladder (micturition reflex) and relaxes the EUS (augmenting reflex). We conducted measurements in a urethane-anaesthetized in vivo rat preparation to characterize systematically the reflexes evoked by fluid flow through the urethra. We used a novel preparation to manipulate sensory feedback from the bladder and urethra independently by controlling bladder volume and urethral flow. We found a distinct bladder volume threshold (74% of bladder capacity) above which flow-evoked bladder contractions were 252% larger and evoked phasic EUS activation 2.6 times as often as responses below threshold, clearly demonstrating a discrete transition between continence (guarding) and micturition (augmenting) reflexes. Below this threshold urethral flow evoked tonic EUS activity, indicative of the guarding reflex, that was proportional to the urethral flow rate. These results demonstrate the complementary roles of sensory feedback from the bladder and urethra in regulating reflexes in the lower urinary tract that depend on the state of the bladder. Understanding the neural control of functional reflexes and how they are mediated by sensory information in the bladder and urethra will open new opportunities, especially in neuromodulation, to treat pathologies of the lower urinary tract. © 2017 The Authors. The Journal of Physiology © 2017 The Physiological Society.

α-Intercalated cells defend the urinary system from bacterial infection.

PubMed

Paragas, Neal; Kulkarni, Ritwij; Werth, Max; Schmidt-Ott, Kai M; Forster, Catherine; Deng, Rong; Zhang, Qingyin; Singer, Eugenia; Klose, Alexander D; Shen, Tian Huai; Francis, Kevin P; Ray, Sunetra; Vijayakumar, Soundarapandian; Seward, Samuel; Bovino, Mary E; Xu, Katherine; Takabe, Yared; Amaral, Fábio E; Mohan, Sumit; Wax, Rebecca; Corbin, Kaitlyn; Sanna-Cherchi, Simone; Mori, Kiyoshi; Johnson, Lynne; Nickolas, Thomas; D'Agati, Vivette; Lin, Chyuan-Sheng; Qiu, Andong; Al-Awqati, Qais; Ratner, Adam J; Barasch, Jonathan

2014-07-01

α-Intercalated cells (A-ICs) within the collecting duct of the kidney are critical for acid-base homeostasis. Here, we have shown that A-ICs also serve as both sentinels and effectors in the defense against urinary infections. In a murine urinary tract infection model, A-ICs bound uropathogenic E. coli and responded by acidifying the urine and secreting the bacteriostatic protein lipocalin 2 (LCN2; also known as NGAL). A-IC-dependent LCN2 secretion required TLR4, as mice expressing an LPS-insensitive form of TLR4 expressed reduced levels of LCN2. The presence of LCN2 in urine was both necessary and sufficient to control the urinary tract infection through iron sequestration, even in the harsh condition of urine acidification. In mice lacking A-ICs, both urinary LCN2 and urinary acidification were reduced, and consequently bacterial clearance was limited. Together these results indicate that A-ICs, which are known to regulate acid-base metabolism, are also critical for urinary defense against pathogenic bacteria. They respond to both cystitis and pyelonephritis by delivering bacteriostatic chemical agents to the lower urinary system.

α–Intercalated cells defend the urinary system from bacterial infection

PubMed Central

Paragas, Neal; Kulkarni, Ritwij; Werth, Max; Schmidt-Ott, Kai M.; Forster, Catherine; Deng, Rong; Zhang, Qingyin; Singer, Eugenia; Klose, Alexander D.; Shen, Tian Huai; Francis, Kevin P.; Ray, Sunetra; Vijayakumar, Soundarapandian; Seward, Samuel; Bovino, Mary E.; Xu, Katherine; Takabe, Yared; Amaral, Fábio E.; Mohan, Sumit; Wax, Rebecca; Corbin, Kaitlyn; Sanna-Cherchi, Simone; Mori, Kiyoshi; Johnson, Lynne; Nickolas, Thomas; D’Agati, Vivette; Lin, Chyuan-Sheng; Qiu, Andong; Al-Awqati, Qais; Ratner, Adam J.; Barasch, Jonathan

2014-01-01

α–Intercalated cells (A-ICs) within the collecting duct of the kidney are critical for acid-base homeostasis. Here, we have shown that A-ICs also serve as both sentinels and effectors in the defense against urinary infections. In a murine urinary tract infection model, A-ICs bound uropathogenic E. coli and responded by acidifying the urine and secreting the bacteriostatic protein lipocalin 2 (LCN2; also known as NGAL). A-IC–dependent LCN2 secretion required TLR4, as mice expressing an LPS-insensitive form of TLR4 expressed reduced levels of LCN2. The presence of LCN2 in urine was both necessary and sufficient to control the urinary tract infection through iron sequestration, even in the harsh condition of urine acidification. In mice lacking A-ICs, both urinary LCN2 and urinary acidification were reduced, and consequently bacterial clearance was limited. Together these results indicate that A-ICs, which are known to regulate acid-base metabolism, are also critical for urinary defense against pathogenic bacteria. They respond to both cystitis and pyelonephritis by delivering bacteriostatic chemical agents to the lower urinary system. PMID:24937428

20 CFR 435.53 - Retention and access requirements for records.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Retention and access requirements for records. 435.53 Section 435.53 Employees' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER NON-PROFIT...

Evolution of post-ESWL residual lithiasis depending on the type of calculus and urine composition.

PubMed

Grases, Felix; Costa-Bauzá, Antonia; Isern, Bernat; Sanchis, Pilar; Perelló, Joan; Hierro, Fernando; Conte Visus, Antonio

2009-07-01

Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures for removal of renal calculi from the upper urinary tract, but complete expulsion of the fragments generated is not always achieved. This can lead to new lithiasic episodes, and it is considered that 10-26% of fragmented calculi can undergo regrowth. This in vitro study investigated the influence of fragment and urinary composition on post-ESWL growth of fragments, with the aims of establishing the effect and importance of these parameters, and identifying effective prophylactic measures. Fragments collected from patients immediately following expulsion after ESWL treatment were selected for regrowth experiments. The particles included 24 calcium oxalate monohydrate (COM) fragments, 48 calcium oxalate dihydrate (COD), 24 hydroxyapatite (HAP), and 16 uric acid. In all treatments, calculi fragments showed a considerable capacity to induce growth of calcium oxalate and calcium phosphate. Under normocalciuria conditions, new COM crystals formed; both COM and COD crystals developed under hypercalciuria conditions at a urinary pH < 6.0; and in hypercalciuric conditions and urinary pH > 6.0 both HAP and brushite (BRU) crystals were formed. The highest growth rates were observed for COD calculi fragments under hypercalciuria conditions and at a urinary pH of 6.5, followed by growth on COM and HAP fragments under the same conditions; growth rates under other conditions tested were similar but 10-fold lower. With regard to the role of crystallization inhibitors, phytate exhibited inhibitory effects under all assay conditions. However, citrate had little effect, even at the highest concentration tested (1,000 mg/L). This study demonstrates the importance of avoiding heterogeneous nucleant retention (pre-existing solid microparticles) in renal cavities, as these can act as very efficient inducers of the formation of new calculi, the composition of which is mainly dependant on the urine composition.

Effect of age and lactose on sup 67 Cu utilization in rats

DOE Office of Scientific and Technical Information (OSTI.GOV)

Link, J.; Dowdy, R.; Michelmann, E.

1991-03-15

Young and old male Fischer 344 rats were fed a control diet or a lactose diet. After four weeks rats were gavaged with approximately 6.24 uCl {sup 67}Cu, placed in metabolism cages, and fed their respective diets for an additional two weeks. Daily whole body, urine and fecal radioactivity measurements were made. Rats were killed on day 42 and livers removed for radioactivity determination. Diet had no effect on whole body retention of {sup 67}Cu in the old rats; approximately 20% of the initial dose was retained by the end of the study. In the young rats, however, lactose appearedmore » to enhance initial {sup 67}Cu retention; by day three young control rats retained only 30% of the initial dose, while the young lactose rats retained about 50%. Retention of {sup 67}Cu at the end of the study was approximately 15% and 20% for young control and young lactose rats, respectively. During the first four days post dosing, cumulative fecal {sup 67}Cu excretion was approximately 83% for young control rats and 69% for young lactose rats indicating enhancement of {sup 67}Cu absorption by lactose in the young rats. For old rats cumulative {sup 67}Cu excretion in feces was about 50% regardless of diet. Cumulative urinary {sup 67}Cu excretion was approximately 6% and 8% for young control and lactose rats, respectively vs about 11% for old rats. {sup 67}Cu retention in liver was greater in old rats regardless of diet. The early increase in {sup 67}Cu absorption after a bolus dose may have therapeutic implications. In light of current concern regarding Cu-carbohydrate interactions, the apparent enhancement Cu retention by lactose in young rats deserves further attention.« less

Monophasic Synovial Sarcoma of Prostatic Fascia: Case Report and Literature Review.

PubMed

Olivetti, Lucio; Benecchi, Luigi; Corti, Serena; Del Boca, Carlo; Ferrari, Matteo; Sergio, Pietro; Bercich, Luisa; Tanzi, Giulia

2015-01-01

Synovial sarcoma (SS) primarily occurs in the para-articular soft tissue of the lower extremities in young adults and it is extremely rare in the prostatic region. We report a case of a 46-year-old man who presented with urinary retention. Pelvic ultrasound (US) examination, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated an 8.5 cm mass that appeared to originate in the prostatic fascia of the right lobe. Preoperative prostatic ultrasound transrectal needle biopsy revealed mesenchymal neoplastic tissue. Patient underwent surgery. The final pathologic findings were consistent with the diagnosis of monophasic synovial sarcoma.

Genitourinary issues during spaceflight: a review.

PubMed

Jones, J A; Jennings, R; Pietryzk, R; Ciftcioglu, N; Stepaniak, P

2005-12-01

The genitourinary (GU) system is not uncommonly affected during previous spaceflights. GU issues that have been observed during spaceflight include urinary calculi, infections, retention, waste management, and reproductive. In-flight countermeasures for each of these issues are being developed to reduce the likelihood of adverse sequelae, due to GU issues during exploration-class spaceflight, to begin in 2018 with flights back to the Moon and on to Mars, according to the February 2004 Presendent's Vision for US Space Exploration. With implementation of a robust countermeasures program, GU issues should not have a significant threat for mission impact during future spaceflights.

Unspecific clinical manifestation of cauda equina myxopapillary ependymoma

PubMed Central

Kariev, Gayrat Maratovich; Halikulov, Elbek Shodievich; Rasulov, Shavkat Orzikuloviich

2015-01-01

A 9-year-old boy admitted to the neurosurgical hospital complaining of headache, vomiting, abdominal pain, and weakness in the arms and legs, urinary retention. Previously, the patient had a treatment of pediatricians. He was examined, magnetic resonance imaging revealed the tumor of the conus medullaris and cauda equina. The surgery was performed with removal myxopapillary ependymoma (ME). Postoperative neurological symptoms regressed; he has received radiotherapy postoperatively. This case illustrates a rare clinical presentation of ME, which simulated intracranial, thoracic, and caudal pathology. We presented features of the clinical presentation, diagnostics, and treatment options of this ependymoma. PMID:26396623

Simultaneous open preperitoneal repair of inguinal hernia with open prostatectomy for benign prostate hyperplasia.

PubMed

Johnson, O Kenneth

2015-01-01

Where surgical resources are slim, patients may suffer the obstructive symptoms of benign prostate hyperplasia until they present with frank urinary retention and they may have unattended inguinal hernia. The best strategy to take care of patients who have both problems at once has remained elusive. We report a small case series of 10 patients in whom open preperitoneal inguinal hernia repair was done together with suprapubic prostatectomy over a 10-year period in the district hospital. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Surfer's myelopathy: case report and review.

PubMed

Karabegovic, Amna; Strachan-Jackman, Shirley; Carr, David

2011-09-01

Nontraumatic spinal cord injury from surfing is a new entity first described in 2004 and likely of ischemic etiology. We report the case of a 25-year-old man who presented to the emergency department with a 2-week history of lower extremity weakness after surfing in Indonesia. The patient reported developing low back pain, lower extremity weakness, sensory changes, and urinary retention shortly after his first surfing lesson. The patient was subsequently diagnosed with surfer's myelopathy. The purpose of this report is to review the clinical presentation, etiology, risk factors, and management of this increasingly described entity.

Rectal ulcer in a patient with VZV sacral meningoradiculitis (Elsberg syndrome).

PubMed

Matsumoto, Hideyuki; Shimizu, Takahiro; Tokushige, Shin-ichi; Mizuno, Hideo; Igeta, Yukifusa; Hashida, Hideji

2012-01-01

This report describes the case of a 55-year-old woman with varicella-zoster virus (VZV) sacral meningoradiculitis (Elsberg syndrome) who presented with herpes zoster in the left S2 dermatome area, urinary retention, and constipation. Lumbar magnetic resonance imaging showed the left sacral nerve root swelling with enhancement. Thereafter, she suddenly showed massive hematochezia and hemorrhagic shock because of a rectal ulcer. To elucidate the relation between Elsberg syndrome and rectal ulcer, accumulation of similar cases is necessary. To avoid severe complications, attention must be devoted to the possibility of rectal bleeding in the early stage of Elsberg syndrome.

78 FR 49359 - Pay Under the General Schedule and Recruitment, Relocation, and Retention Incentives

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-14

.... Agencies may, in their agency retention incentive plans, require documentation of private-sector job offers... Schedule and Recruitment, Relocation, and Retention Incentives AGENCY: U.S. Office of Personnel Management... to improve oversight of recruitment and retention incentive determinations; add succession planning...

16 CFR 312.10 - Data retention and deletion requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... CONGRESS CHILDREN'S ONLINE PRIVACY PROTECTION RULE § 312.10 Data retention and deletion requirements. An operator of a Web site or online service shall retain personal information collected online from a child...

Human absorption and retention of polonium-210 from caribou meat.

PubMed

Thomas, P A; Fisenne, I; Chorney, D; Baweja, A S; Tracy, B L

2001-01-01

The gastrointestinal (GI) absorption factors and the biological retention times for polonium were determined for a group of 14 volunteers--seven men and seven women--from Saskatoon, Saskatchewan, Canada. Each volunteer consumed 2.0 kg of caribou meat containing known amounts of naturally occurring 210Po. Urine and faecal samples were collected for up to 65 days after meat consumption and analysed for 210Po. The average GI absorption factor for the 14 volunteers was 56 +/- 4% (range = 31-71%), not significantly different from the ICRP value of 50%. About 3% of absorbed polonium underwent prompt excretion by the urinary pathway. The remainder was retained by the body with a half-time >100 days, compared to the ICRP value of 50 days. The effect of these findings increases the dose estimate for ingestion of 210Po in food by a factor of 1.5 to 3.5. Thus, background doses to people consuming caribou and reindeer may be higher than previously thought.

Colon transit scintiraphy in health and constipation using oral iodine-131-cellulose

DOE Office of Scientific and Technical Information (OSTI.GOV)

McLean, R.G.; Smart, R.C.; Gaston-Parry, D.

1990-06-01

The purpose of the study was to assess if a new scintigraphic method for noninvasive assessment of colonic transit could differentiate between subjects with normal bowel transit and those with constipation. Eleven normal subjects and 29 constipated patients were given 4 MBq iodine-131-cellulose ({sup 131}I-cellulose) orally and sequential abdominal scans were performed at 6, 24, 48, 72, and 96 hr from which total and segmental percent retentions were calculated. There were clear differences between the normal subjects and the constipated patients for the total percent retention at all time intervals, on a segmental basis in the right colon at 24more » hr, and in all segments at 48 and 72 hr. Three-day urinary excretion of radioiodine was minimal; 2.4% +/- 1.2% (mean +/- s.d.) in constipated patients and 3.1% +/- 0.8% in normals, with approximately 75% occurring in the first day. The use of oral radiotracers in the investigation of constipation appears promising.« less

7 CFR 3016.42 - Retention and access requirements for records.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Retention and access requirements for records. 3016.42 Section 3016.42 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND...

10 CFR 603.905 - Record retention requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... retention requirements. A TIA must require participants to keep records related to the TIA (for which the... final financial status report for an expenditure-based TIA or final program performance report for a fixed-support TIA, with the following exceptions: (a) The participant must keep records longer than...

Electronic Monitoring Systems to Assess Urinary Incontinence: A Health Technology Assessment

PubMed Central

Nevis, Immaculate; Kabali, Conrad; Anh Tu, Hong; Ekanayake, Samanthika; Mistry, Jigna; Wells, David; Ali, Arshia; Walter, Melissa; Higgins, Caroline

2018-01-01

Background Urinary incontinence is involuntary leakage of urine and can affect people of all ages. Incidence rises as people age, often because of reduced mobility or conditions affecting the nervous system, such as dementia and stroke. Urinary incontinence can be a distressing condition and can harm a person's physical, financial, social, and emotional well-being. People with urinary incontinence are susceptible to skin irritation, pressure sores, and urinary tract infections. Urinary incontinence is also associated with an increased risk of falls in older adults. This health technology assessment examined the effectiveness of, budget impact of, and patient values and preferences about electronic monitoring systems to assess urinary incontinence for residents of long-term care homes or geriatric hospital inpatients with complex conditions. Methods A clinical evidence review of the published clinical literature was conducted to June 9, 2017. Critical appraisal of the clinical evidence included assessment of risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria to reflect the certainty of the evidence. We calculated the funding required for an electronic urinary incontinence monitoring system in the first year of implementation (when facilities would buy the systems) and in subsequent years. We interviewed six people with urinary incontinence and two caregivers, who described ways urinary incontinence affected daily life. Results We included one observational study in the clinical review. Most of the 31 participants in the observational study were female (78%) and required high levels of care, primarily because of cognitive impairment. The quality of evidence for all outcomes was very low owing to potential risk of bias and indirectness. We are consequently uncertain about how electronic monitoring systems affect management of urinary incontinence. For patients living in long-term care homes who are eligible for the technology, we estimated that an electronic monitoring system to assess urinary incontinence would cost $6.4 million in the first year of implementation and $1.6 million in subsequent years. Patients said urinary incontinence reduced their independence and social life and adversely affected their quality of life. Incontinence made them embarrassed and reduced their self-esteem. Several respondents mentioned how expensive supplies to manage incontinence were. Conclusions The effectiveness of using the electronic monitoring system to assess urinary incontinence is uncertain because of the very low quality of the evidence. Introducing electronic monitoring systems would result in incremental costs, and there would be savings only if the systems substantially reduced incontinence. PMID:29844845

Electronic Monitoring Systems to Assess Urinary Incontinence: A Health Technology Assessment.

PubMed

2018-01-01

Urinary incontinence is involuntary leakage of urine and can affect people of all ages. Incidence rises as people age, often because of reduced mobility or conditions affecting the nervous system, such as dementia and stroke. Urinary incontinence can be a distressing condition and can harm a person's physical, financial, social, and emotional well-being. People with urinary incontinence are susceptible to skin irritation, pressure sores, and urinary tract infections. Urinary incontinence is also associated with an increased risk of falls in older adults.This health technology assessment examined the effectiveness of, budget impact of, and patient values and preferences about electronic monitoring systems to assess urinary incontinence for residents of long-term care homes or geriatric hospital inpatients with complex conditions. A clinical evidence review of the published clinical literature was conducted to June 9, 2017. Critical appraisal of the clinical evidence included assessment of risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria to reflect the certainty of the evidence.We calculated the funding required for an electronic urinary incontinence monitoring system in the first year of implementation (when facilities would buy the systems) and in subsequent years.We interviewed six people with urinary incontinence and two caregivers, who described ways urinary incontinence affected daily life. We included one observational study in the clinical review. Most of the 31 participants in the observational study were female (78%) and required high levels of care, primarily because of cognitive impairment. The quality of evidence for all outcomes was very low owing to potential risk of bias and indirectness. We are consequently uncertain about how electronic monitoring systems affect management of urinary incontinence.For patients living in long-term care homes who are eligible for the technology, we estimated that an electronic monitoring system to assess urinary incontinence would cost $6.4 million in the first year of implementation and $1.6 million in subsequent years.Patients said urinary incontinence reduced their independence and social life and adversely affected their quality of life. Incontinence made them embarrassed and reduced their self-esteem. Several respondents mentioned how expensive supplies to manage incontinence were. The effectiveness of using the electronic monitoring system to assess urinary incontinence is uncertain because of the very low quality of the evidence. Introducing electronic monitoring systems would result in incremental costs, and there would be savings only if the systems substantially reduced incontinence.

Acute Bacterial Prostatitis: Diagnosis and Management.

PubMed

Coker, Timothy J; Dierfeldt, Daniel M

2016-01-15

Acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise. Although the true incidence is unknown, acute bacterial prostatitis is estimated to comprise approximately 10% of all cases of prostatitis. Most acute bacterial prostatitis infections are community acquired, but some occur after transurethral manipulation procedures, such as urethral catheterization and cystoscopy, or after transrectal prostate biopsy. The physical examination should include abdominal, genital, and digital rectal examination to assess for a tender, enlarged, or boggy prostate. Diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis. Urine cultures should be obtained in all patients who are suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitivity pattern. Additional laboratory studies can be obtained based on risk factors and severity of illness. Radiography is typically unnecessary. Most patients can be treated as outpatients with oral antibiotics and supportive measures. Hospitalization and broad-spectrum intravenous antibiotics should be considered in patients who are systemically ill, unable to voluntarily urinate, unable to tolerate oral intake, or have risk factors for antibiotic resistance. Typical antibiotic regimens include ceftriaxone and doxycycline, ciprofloxacin, and piperacillin/tazobactam. The risk of nosocomial bacterial prostatitis can be reduced by using antibiotics, such as ciprofloxacin, before transrectal prostate biopsy.

Medical and minimally invasive therapies for the treatment of benign prostatic hyperplasia.

PubMed

Harkaway, R C; Issa, M M

2006-01-01

Over the last decade, management of benign prostatic hyperplasia (BPH) has changed with a substantial decrease in the use of transurethral prostatectomy (TURP) and a simultaneous increase in the use of medical therapy and minimally invasive surgical therapy (MIST). The goal of management of this chronic progressive condition is not only to provide relief of lower urinary tract symptoms (LUTS) but also to reduce the lifetime risk of adverse outcomes. Recent clinical evidence has demonstrated a clear role for medical therapy, particularly with 5-alpha-reductase inhibitors (5ARIs) either alone or in combination with alpha-blockers, to reduce the risk of acute urinary retention and need for surgery and provide symptom relief. Clinical data on MISTs also indicate a more pronounced short-term effect; however, the long-term durability of these therapies remains uncertain. Minimally invasive surgical therapies confer treatment benefits in a single 1-h treatment session under local anesthesia. Recovery times and adverse events are improved compared with TURP, but issues such as hematuria, prolonged catheterization, urinary tract infection and retreatment remain commonly reported issues. Today, urologists are faced with the challenge of identifying the most appropriate treatment option for the long-term management of BPH. The initial choice for any given patient will depend on his presenting circumstances and the influence of treatment risks on these circumstances. Providing patients with informed treatment decisions is a key element of management.

Policies and Practice: A Focus on Higher Education Retention.

ERIC Educational Resources Information Center

American Association of State Colleges and Universities, Washington, DC.

This book, based on a discussion at an interactive videoconference, examines student diversity issues and retention strategies in the context of the Sallie Mae National Retention Project that addressed state expectations for more accountability and federal reporting requirements on graduation and retention. The eight chapters focus on equity as it…

Pregnancy after orthotopic continent urinary diversion.

PubMed

Kennedy, W A; Hensle, T W; Reiley, E A; Fox, H E; Haus, T

1993-10-01

Continent urinary diversion has become a common form of bladder management for the female exstrophy patient in whom primary reconstruction has failed. Reported are the results of successful pregnancies in four young adult females, who had previously undergone a flap vaginoplasty as part of earlier management and more recently a continent right colonic urinary reservoir with a perineal stoma (Indiana pouch). Pregnancy in each of these patients was characterized by several urinary tract infections, cervical prolapse and mild to severe maternal hydronephrosis. All of the patients had some degree of difficulty with clean intermittent catheterization. One patient required an indwelling catheter with prolonged bed rest. Maternal hydronephrosis resolved after delivery in all instances. All four patients delivered their infants by way of cesarean section, either emergently for maternal or fetal distress or electively. Cervical prolapse did not resolve in three patients and will require surgical repair. After delivery, all patients returned to their previous pattern of clean intermittent catheterization without loss of continence. All the infants delivered were healthy with appropriate weights and high Apgar scores (more than 8). Orthotopic (perineal stoma) continent urinary diversion is not a contraindication to pregnancy. However, our experience mandates delivery by cesarean section with close monitoring for maternal or fetal distress during gestation.

Mental health of Chinese primary care patients with lower urinary tract symptoms.

PubMed

Choi, Edmond P H; Lam, Cindy L K; Chin, Weng Yee

2016-01-01

The aim of this study was to evaluate the mental health of Chinese primary care patients with lower urinary tract symptoms (LUTS). This was a cross-sectional observational study. Five hundred and nineteen subjects with LUTS completed a structured questionnaire containing the Depression, Anxiety, and Stress Scale-Short Form, the International Prostate Symptom Score, the adapted International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and questions about socio-demographics. Overall, 17.7% of subjects reported depressive symptoms, 24.3% anxiety symptoms and 9.6% stress symptoms. In males, demographic factors associated with poorer mental health included being not married; clinical factors included higher LUTS severity, weak stream, straining and mixed urinary incontinence. In females, demographic factors associated with poorer mental health included being younger, not married and lower household income; clinical factors included higher LUTS severity, incomplete bladder emptying, urgency and weak stream. Chinese primary care patients with LUTS appear to be an at-risk group for poorer mental health with increased prevalence of anxiety and depressive symptoms and may require routine screening to identify those who may require more tailored interventions to address both their urinary symptoms and psychological distress.

Dietary phosphorus restriction to half the minimum required amount slightly reduces weight gain and length of tibia, but sustains femur mineralization and prevents nephrocalcinosis in female kittens.

PubMed

Pastoor, F J; Opitz, R; Van 't Klooster, A T; Beynen, A C

1995-07-01

The effects of dietary P restriction to half the recommended minimum level on growth, bone and renal mineralization and urinary composition were studied in female kittens. In two separate experiments, 8-week-old weanling kittens were fed on purified diets containing either 4.6 or 9.2 mmol P/MJ (2.8 or 5.6 g P/kg diet). In the second experiment there was an additional low-P diet in which the Ca concentration was reduced from 9.5 to 4.8 mmol/MJ (7.5 v. 3.8 g Ca/kg diet). P restriction slightly but systematically reduced weight gain (to a maximum of 16%) and growth of the tibia (by 1-4%); the former effect was statistically significant (P < 0.05) between the ages of 15 and 20 weeks in Expt 1 only, and the latter did not reach statistical significance at any time point (P > or = 0.13). No adverse effect of P restriction was found on mineralization of femur at the age of 39 weeks. Kidney Ca concentrations were significantly lowered (Expt 1, 6 v. 20 mumol/g dry weight, P < 0.001; Expt 2, 7 v. 16 mumol/g dry weight, P < 0.01) in cats fed on the low-P diets, this effect not being affected by the dietary Ca:P ratio. Urinary P concentration was significantly depressed (by 50-96%) after feeding the low-P diets (P < 0.001). P intake did not influence P, Ca and Mg retention during the period of 15 to 39 weeks of age.

22 CFR 226.53 - Retention and access requirements for records.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Retention and access requirements for records. 226.53 Section 226.53 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Reports and Records § 226.53...

32 CFR 32.53 - Retention and access requirements for records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Retention and access requirements for records. 32.53 Section 32.53 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports...

32 CFR 32.53 - Retention and access requirements for records.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 1 2011-07-01 2011-07-01 false Retention and access requirements for records. 32.53 Section 32.53 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports...

Stenting Prior to Cystectomy is an Independent Risk Factor for Upper Urinary Tract Recurrence.

PubMed

Kiss, Bernhard; Furrer, Marc A; Wuethrich, Patrick Y; Burkhard, Fiona C; Thalmann, George N; Roth, Beat

2017-12-01

Patients with bladder cancer who present with hydronephrosis may require drainage of the affected kidney before receiving further cancer treatment. Drainage can be done by retrograde stenting or percutaneously. However, retrograde stenting carries the risk of tumor cell spillage to the upper urinary tract. The aim of this study was to evaluate whether patients with bladder cancer are at higher risk for upper urinary tract recurrence if retrograde stenting has been performed prior to radical cystectomy. We retrospectively analyzed the records of 1,005 consecutive patients with bladder cancer who underwent radical cystectomy at our department between January 2000 and June 2016. Negative intraoperative ureteral margins were mandatory for study inclusion. Patients received regular followup according to our institutional protocol, including imaging of the upper urinary tract and urine cytology. Preoperative drainage of the upper urinary tract was performed in 114 of the 1,005 patients (11%), including in 53 (46%) by Double-J® stenting and in 61 (54%) by percutaneous nephrostomy. Recurrence developed in the upper urinary tract in 31 patients (3%) at a median of 17 months after cystectomy, including 7 of 53 (13%) in the Double-J group, 0% in the nephrostomy group and 24 of 891 (3%) in the no drainage group. Multivariate regression analysis revealed a higher risk of upper urinary tract recurrence if patients underwent Double-J stenting (HR 4.54, 95% CI 1.43-14.38, p = 0.01) and preoperative intravesical instillations (HR 2.94, 95% CI 1.40-6.16, p = 0.004). Patients who undergo Double-J stenting prior to radical cystectomy are at higher risk for upper urinary tract recurrence. If preoperative upper urinary tract drainage is required, percutaneous drainage might be recommended. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Long-Term Outcomes of Renal Transplant in Recipients With Lower Urinary Tract Dysfunction.

PubMed

Wilson, Rebekah S; Courtney, Aisling E; Ko, Dicken S C; Maxwell, Alexander P; McDaid, James

2018-01-02

Lower urinary tract dysfunction can lead to chronic kidney disease, which, despite surgical intervention, will progress to end-stage renal disease, requiring dialysis. Urologic pathology may damage a transplanted kidney, limiting patient and graft survival. Although smaller studies have suggested that urinary tract dysfunction does not affect graft or patient survival, this is not universally accepted. Northern Ireland has historically had the highest incidence of neural tube defects in Europe, giving rich local experience in caring for patients with lower urinary tract dysfunction. Here, we analyzed outcomes of renal transplant recipients with lower urinary tract dysfunction versus control recipients. We identified 3 groups of kidney transplant recipients treated between 2001 and 2010; those in group 1 had end-stage renal disease due to lower urinary tract dysfunction with prior intervention (urologic surgery, long-term catheter, or intermittent self-catheterization), group 2 had end-stage renal disease secondary to lower urinary tract dysfunction without intervention, and group 3 had end-stage renal disease due to polycystic kidney disease (chosen as a relatively healthy control cohort without comorbid burden of other causes of end-stage renal disease such as diabetes). The primary outcome measured, graft survival, was death censored, with graft loss defined as requirement for renal replacement therapy or retransplant. Secondary outcomes included patient survival and graft function. In 150 study patients (16 patients in group 1, 64 in group 2, and 70 in group 3), 5-year death-censored graft survival was 93.75%, 90.6%, and 92.9%, respectively, with no significant differences in graft failure among groups (Cox proportional hazards model). Five-year patient survival was 100%, 100%, and 94.3%, respectively. Individuals with a history of lower urinary tract dysfunction had graft and patient survival rates similar to the control group. When appropriately treated, lower urinary tract dysfunction is not a barrier to successful renal transplant.

Biofabrication and biomaterials for urinary tract reconstruction

PubMed Central

Elsawy, Moustafa M; de Mel, Achala

2017-01-01

Reconstructive urologists are constantly facing diverse and complex pathologies that require structural and functional restoration of urinary organs. There is always a demand for a biocompatible material to repair or substitute the urinary tract instead of using patient’s autologous tissues with its associated morbidity. Biomimetic approaches are tissue-engineering tactics aiming to tailor the material physical and biological properties to behave physiologically similar to the urinary system. This review highlights the different strategies to mimic urinary tissues including modifications in structure, surface chemistry, and cellular response of a range of biological and synthetic materials. The article also outlines the measures to minimize infectious complications, which might lead to graft failure. Relevant experimental and preclinical studies are discussed, as well as promising biomimetic approaches such as three-dimensional bioprinting. PMID:28546955

Conservative Management of Urinary Incontinence in Women

PubMed Central

Faiena, Izak; Patel, Neal; Parihar, Jaspreet S; Calabrese, Marc; Tunuguntla, Hari

2015-01-01

Urinary incontinence in women has a high prevalence and causes significant morbidity. Given that urinary incontinence is not generally a progressive disease, conservative therapies play an integral part in the management of these patients. We conducted a nonsystematic review of the literature to identify high-quality studies that evaluated the different components of conservative management of stress urinary incontinence, including behavioral therapy, bladder training, pelvic floor muscle training, lifestyle changes, mechanical devices, vaginal cones, and electrical stimulation. Urinary incontinence can have a severe impact on our healthcare system and patients’ quality of life. There are currently a wide variety of treatment options for these patients, ranging from conservative treatment to surgical treatment. Although further research is required in the area of conservative therapies, nonsurgical treatments are effective and are preferred by some patients. PMID:26543427

Solifenacin improves double-J stent-related symptoms in both genders following uncomplicated ureteroscopic lithotripsy.

PubMed

Lee, Yuan-Ju; Huang, Kuo-How; Yang, Hung-Ju; Chang, Hong-Chiang; Chen, Jun; Yang, Teng-Kai

2013-06-01

The objective of this study is to evaluate the effects of solifenacin on double-J stent-related symptoms following uncomplicated ureterosocpic lithotripsy (URSL). A total of 70 patients who underwent double-J ureteral stent insertion following URSL were consecutively recruited and received solifenacin postoperatively. Another 70 age- and sex-matched subjects without solifenacin therapy were enrolled as a control group. The clinical data including stone and stent characteristics were collected. All subjects completed the brief-form Ureteral Symptom Score Questionnaire (Chinese-version) to assess the lower urinary tract symptoms, stent-related body pain and hematuria 2 weeks after operation. The severity of stent-related symptoms was compared between two groups. The mean age was 53.8 in solifenacin group and 53.4 years in the control group (p = 0.87). The stone characteristics, stent size, position and curl completeness were similar in both groups. Compared to the control group, solifenacin group had significantly lower total symptom score, urgency and urge incontinence scores. As for stent-related body pain, solifenacin group had significantly less flank, abdominal, urethral pain and hematuria scores (all p < 0.05). The solifenacin versus control group showed significant benefits in lower urinary tract symptoms, stent-related pain and hematuria in both genders (all p < 0.05). Four subjects encountered minor adverse events (5.7 %) and one had urinary retention (1.4 %) in solifenacin group. For patients undergoing URSL and double-J stent indwelling, postoperative solifenacin use was effective and well-tolerated for the treatment of lower urinary tract symptoms, stent-related body pain and hematuria irrespective of genders.

Efficacy and Safety of Initial Combination Treatment of an Alpha Blocker with an Anticholinergic Medication in Benign Prostatic Hyperplasia Patients with Lower Urinary Tract Symptoms: Updated Meta-Analysis.

PubMed

Kim, Hyun Jung; Sun, Hwa Yeon; Choi, Hoon; Park, Jae Young; Bae, Jae Hyun; Doo, Seung Whan; Yang, Won Jae; Song, Yun Seob; Ko, Young Myoung; Kim, Jae Heon

2017-01-01

There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS). The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis. We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL). In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls). The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14-0.08). The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 - -0.17). The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 - -0.07), 0.00 (95% CI: -0.08-0.08), and 0.56 (95% CI: 0.23-0.89), respectively. There was no significant difference in the number of acute urinary retention (AUR) events or PVR. Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/ LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function.

Efficacy and Safety of Initial Combination Treatment of an Alpha Blocker with an Anticholinergic Medication in Benign Prostatic Hyperplasia Patients with Lower Urinary Tract Symptoms: Updated Meta-Analysis

PubMed Central

Kim, Hyun Jung; Sun, Hwa Yeon; Choi, Hoon; Park, Jae Young; Bae, Jae Hyun; Doo, Seung Whan; Yang, Won Jae; Song, Yun Seob; Ko, Young Myoung

2017-01-01

Background There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) Objective The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis. Methods We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL). Results In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls). The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14–0.08). The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 - -0.17). The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 - -0.07), 0.00 (95% CI: -0.08–0.08), and 0.56 (95% CI: 0.23–0.89), respectively. There was no significant difference in the number of acute urinary retention (AUR) events or PVR. Conclusions Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/ LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function. PMID:28072862

Effects of dietary benzoic acid and sodium-benzoate on performance, nitrogen and mineral balance and hippuric acid excretion of piglets.

PubMed

Gräber, Tobias; Kluge, Holger; Hirche, Frank; Broz, Jirí; Stangl, Gabriele I

2012-06-01

The objective of this study was to compare the effects of sodium-benzoate (NaB) with those of benzoic acid (BAc) on growth performance of piglets as well as nutrient digestibility, nitrogen and mineral balance, urinary pH, and the urinary excretion of BAc and hippuric acid (HAc). The study was conducted with 120 weaning piglets (6.5 kg body weight), divided in four groups (15 replicates of two piglets each), which received (1) a basal diet (Control), or the basal diet supplemented with (2) 4 g NaB per kg (Group 4NaB), (3) 3.5 g BAc per kg (Group 3.5BAc) or (4) 5 g BAc per kg (Group 5BAc). Performance data were monitored over a 42-day period. Urine and faeces were collected from day 28-33 in metabolic cages with five piglets per treatment. Piglets of Groups 3.5BAc and 5BAc had similarly a considerably improved average daily gain and feed intake (p < 0.05). Performance of Group 4NaB was not significantly different from the other groups. Compared to the Control, the nitrogen retention was only improved in Group 5BAc (p < 0.05); the other groups showed intermediate values. In the supplemented groups, most of the BAc was excreted as HAc in urine, but only Groups 3.5BAc and 5BAc had reduced urinary pH (p < 0.05). Daily intake and faecal and urinary excretion of P and Ca were not affected by the treatment. The molar excess of Na in Group 4NaB was reflected by higher renal excretion of Na compared to the other groups (p < 0.05).

Effect of dietary copper on the copper content of urine, parotid saliva, and sweat in humans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Turnlund, J.R.

Eleven young men were confined to a metabolic research unit to study the effect of the level of dietary copper (Cu) on Cu metabolism. They were fed a constant diet containing the following three levels of dietary Cu: adequate Cu (1.68 mg/d) for 24 days (MP1), low Cu (0.785 mg/d) for 42 days (MP2), and high Cu (7.53 mg/d) for 24 days (MP3). Urine was collected throughout the study and Cu was determined in 6-day pools from the beginning of the study, the end of each MP, and the midpoint of MP2. Parotid saliva was collected near the end ofmore » each MP. Sweat was collected from the upper arm and ancillary area of three subjects for 2-day periods near the end of each MP. Urinary Cu averaged 0.34, 0.34 and 0.33 {mu}mol/d for MP 1, 2, and 3, respectively. Individual averages ranged from 0.16 to 0.39 {mu}mol/d. Parotid saliva Cu averaged 13.4, 13.0, and 12.0 nmol/L for MP 1, 2 and 3, respectively. Individual averages ranged from 6.9 to 17.8 nmol/L. Sweat Cu levels were very low and did not appear to be affected by dietary Cu. The limited data suggest that sweat losses would have little effect on Cu balance. Neither urinary nor salivary Cu was affected by dietary Cu or related to indices of Cu status (serum Cu, ceruloplasmin, or erythrocyte superoxide dismutase). Urinary and salivary Cu differed significantly among individuals. Results suggest that urinary, salivary, and sweat Cu do not play a role in regulating Cu retention or affect Cu status of humans.« less

[Efficacy of periurethral injections of polyacrylamide hydrogel (Bulkamid(®)) and quality of life of patients with urinary incontinence due to sphincter deficiency (IUE-IS)].

PubMed

Beraru, A; Droupy, S; Wagner, L; Soustelle, L; Muyschondt, C; Ben Naoum, K; Grés, P; Boukaram, M; Costa, P

2014-06-01

This study was carried out to evaluate the efficacy of periurethral injection of polyacrylamide hydrogel (PAHG, Bulkamid(®), Ethicon) for the treatment of female stress urinary incontinence (SUI). Single-center prospective study: periurethral injection of Bulkamid(®) was performed in 80 patients with severe urinary incontinence between June 2010 and October 2011. The evaluation of the impact on quality of life was carried out using the Patient Global Impression of Severity (PGI-S), the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and Patient Global Impression of Improvement (PGI-I) before and after treatment. With a mean follow-up of 18.6 ± 5.3 months, 60% of patients had improved. For 30/74 (40%) there was no improvement and no patient had worsening of PGI-I after injection. Before surgery, 55.4% of patients considered their condition as severe (PGI-S). After injecting 21/74 (28%) and 11/74 (15%) considered it normal and severe (zero leakage). The ICIQ -SF score increased from 17 ± 2.84 before injection to 13 ± 5.52 after surgery, with a significant 30% decrease (P<0.00001). The reinjection rate was 29%. The complication rate was 16% (17/108): 11 cases of transient postoperative retention, 2 cases of cystitis, dysuria four episodes. No abscess or infection at the injection site, no specific complication to the product used. With an (PGI-I) improvement rate of 60 and 15% of patients without leakage (PGI-S/ICIQ), periurethral injection of Bulkamid(®) is an effective and safe treatment option for women with a severe urinary incontinence especially in therapeutic failure. 4. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Effects of Orthosiphon grandiflorus, Hibiscus sabdariffa and Phyllanthus amarus extracts on risk factors for urinary calcium oxalate stones in rats.

PubMed

Woottisin, Surachet; Hossain, Rayhan Zubair; Yachantha, Chatchai; Sriboonlue, Pote; Ogawa, Yoshihide; Saito, Seiichi

2011-01-01

We evaluated the antilithic effect of Orthosiphon grandiflorus, Hibiscus sabdariffa and Phyllanthus amarus extracts on known risk factors for calcium oxalate stones in rats. We divided 30 male Wistar rats into 5 equal groups. Controls were fed a standard diet and the remaining groups received a 3% glycolate diet for 4 weeks to induce hyperoxaluria. One glycolate fed group served as the untreated group and the others were given oral extracts of Orthosiphon grandiflorus, Hibiscus sabdariffa or Phyllanthus amarus at a dose of 3.5 mg daily. We collected 24-hour urine and blood samples. Kidneys were harvested for histological examination. We measured the renal tissue content of calcium and oxalate. The Hibiscus sabdariffa group showed significantly decreased serum oxalate and glycolate, and higher oxalate urinary excretion. The Phyllanthus amarus group showed significantly increased urinary citrate vs the untreated group. Histological examination revealed less CaOx crystal deposition in the kidneys of Hibiscus sabdariffa and Phyllanthus amarus treated rats than in untreated rats. Those rats also had significantly lower renal tissue calcium content than untreated rats. All parameters in the Orthosiphon grandiflorus treated group were comparable to those in the untreated group. Hibiscus sabdariffa and Phyllanthus amarus decreased calcium crystal deposition in the kidneys. The antilithic effect of Hibiscus sabdariffa may be related to decreased oxalate retention in the kidney and more excretion into urine while that of Phyllanthus amarus may depend on increased urinary citrate. In contrast, administering Orthosiphon grandiflorus had no antilithic effect. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Proteus mirabilis fimbriae- and urease-dependent clusters assemble in an extracellular niche to initiate bladder stone formation

PubMed Central

Schaffer, Jessica N.; Norsworthy, Allison N.; Sun, Tung-Tien

2016-01-01

The catheter-associated uropathogen Proteus mirabilis frequently causes urinary stones, but little has been known about the initial stages of bladder colonization and stone formation. We found that P. mirabilis rapidly invades the bladder urothelium, but generally fails to establish an intracellular niche. Instead, it forms extracellular clusters in the bladder lumen, which form foci of mineral deposition consistent with development of urinary stones. These clusters elicit a robust neutrophil response, and we present evidence of neutrophil extracellular trap generation during experimental urinary tract infection. We identified two virulence factors required for cluster development: urease, which is required for urolithiasis, and mannose-resistant Proteus-like fimbriae. The extracellular cluster formation by P. mirabilis stands in direct contrast to uropathogenic Escherichia coli, which readily formed intracellular bacterial communities but not luminal clusters or urinary stones. We propose that extracellular clusters are a key mechanism of P. mirabilis survival and virulence in the bladder. PMID:27044107

76 FR 49368 - Atlantic Highly Migratory Species; Modification of the Retention of Incidentally-Caught Highly...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-10

.... 110112022-1262-02] RIN 0648-BA45 Atlantic Highly Migratory Species; Modification of the Retention of.... SUMMARY: This final rule modifies the permitting requirements and retention limits for Atlantic highly... establishes a retention limit for smoothhound sharks in all Atlantic trawl fisheries. These actions are...

41 CFR 101-27.304-1 - Establishment of economic retention limit.

Code of Federal Regulations, 2012 CFR

2012-07-01

... economic retention limit. 101-27.304-1 Section 101-27.304-1 Public Contracts and Property Management... economic retention limit. An economic retention limit must be established for inventories so that the... it is required. Generally, it would be more economical to dispose of stock in excess of the limit and...

Relationships between urinary electrolytes excretion and central hemodynamics, and arterial stiffness in hypertensive patients.

PubMed

Han, Weizhong; Han, Xiao; Sun, Ningling; Chen, Yunchao; Jiang, Shiliang; Li, Min

2017-08-01

High sodium intake plays an important role in the onset and exacerbation of hypertension. However, the relationships between urinary electrolytes excretion and central hemodynamics and between urinary electrolyte excretion and arterial stiffness are still the subject of debate. This study sought to clarify the associations of salt intake with central aortic pressure and arterial stiffness indicators. A total of 431 untreated hypertensive individuals were recruited into the study. Twenty-four-hour urinary samples were collected to measure the excretion of urinary electrolytes. Central hemodynamics parameters and brachial-ankle pulse wave velocity (baPWV) were measured. We evaluated the independent relationship between urinary sodium or potassium excretion and the abovementioned indices. The mean 24-h urinary sodium of all subjects was 166.6±70.0 mmol/24 h. With increases in urinary sodium excretion, central blood pressure and baPWV values markedly increased. Multiple regression analysis showed that urinary sodium was independently associated with increases in central systolic blood pressure, central diastolic blood pressure, the augmentation index, and baPWV. Significant correlations were identified between high dietary sodium and central hemodynamics and between high dietary sodium and arterial elasticity. Prospective interventional studies in hypertensive patients may be required to determine the effect of salt intake on central hemodynamics.

Subacute combined degeneration of the spinal cord in a patient abusing nitrous oxide and self-medicating with cyanocobalamin.

PubMed

Pugliese, Robert S; Slagle, Evan J; Oettinger, Glenn R; Neuburger, Kenneth J; Ambrose, Timothy M

2015-06-01

A case of subacute combined degeneration (SCD) of the spinal cord manifesting as severe ataxia and urinary retention in a patient with a history of heavy nitrous oxide abuse and self-supplementation with cyanocobalamin is reported. A 27-year-old woman was treated in the emergency department for complaints of abdominal pain and inability to urinate for about 12 hours. The patient also complained of worsening lower-extremity weakness for 10 days and a "pins and needles" sensation in the lower extremities for approximately 1 year. She reported nitrous oxide abuse over 3 years (an average of 100-200 "whippit" cartridges daily on 3 or 4 days per week), as well as long-term self-medication with oral and i.m. cyanocobalamin for the purpose of preventing nitrous oxide-induced neurologic symptoms. Results of magnetic resonance imaging (MRI) were highly suggestive of SCD, which is typically seen in primary vitamin B12 deficiency but has been reported in the context of chronic nitrous oxide exposure. Treatment was initiated with cyanocobalamin 1000 μg i.m. daily, to be continued for 5 days and followed by a four-week regimen of 1000 μg i.m. weekly. The patient was discharged after 3 days, despite continued symptoms, with instructions to obtain ongoing care but was lost to follow-up. A patient who abused nitrous oxide chronically developed ataxia, paresthesia, and urinary retention while self-medicating with cyanocobalamin. A diagnosis of SCD was supported by MRI findings, symptoms, and the known relationship between nitrous oxide exposure and vitamin B12 deficiency. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Pretreatment Nomogram to Predict the Risk of Acute Urinary Retention After I-125 Prostate Brachytherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roeloffzen, Ellen M., E-mail: e.m.a.roeloffzen@umcutrecht.nl; Vulpen, Marco van; Battermann, Jan J.

Purpose: Acute urinary retention (AUR) after iodine-125 (I-125) prostate brachytherapy negatively influences long-term quality of life and therefore should be prevented. We aimed to develop a nomogram to preoperatively predict the risk of AUR. Methods: Using the preoperative data of 714 consecutive patients who underwent I-125 prostate brachytherapy between 2005 and 2008 at our department, we modeled the probability of AUR. Multivariate logistic regression analysis was used to assess the predictive ability of a set of pretreatment predictors and the additional value of a new risk factor (the extent of prostate protrusion into the bladder). The performance of the finalmore » model was assessed with calibration and discrimination measures. Results: Of the 714 patients, 57 patients (8.0%) developed AUR after implantation. Multivariate analysis showed that the combination of prostate volume, IPSS score, neoadjuvant hormonal treatment and the extent of prostate protrusion contribute to the prediction of AUR. The discriminative value (receiver operator characteristic area, ROC) of the basic model (including prostate volume, International Prostate Symptom Score, and neoadjuvant hormonal treatment) to predict the development of AUR was 0.70. The addition of prostate protrusion significantly increased the discriminative power of the model (ROC 0.82). Calibration of this final model was good. The nomogram showed that among patients with a low sum score (<18 points), the risk of AUR was only 0%-5%. However, in patients with a high sum score (>35 points), the risk of AUR was more than 20%. Conclusion: This nomogram is a useful tool for physicians to predict the risk of AUR after I-125 prostate brachytherapy. The nomogram can aid in individualized treatment decision-making and patient counseling.« less

Expression of Hsp27 correlated with rat detrusor contraction after acute urinary retention.

PubMed

Xiong, Zhiyong; Wang, Yongquan; Gong, Wei; Zhou, Zhansong; Lu, Gensheng

2013-09-01

Heat shock protein 27 (Hsp27) can regulate actin cytoskeleton dynamics and contractile protein activation. This study investigates whether Hsp27 expression is related to bladder contractile dysfunction after acute urinary retention (AUR). Female rats were randomized either to AUR by urethral ligation or to normal control group. Bladder and smooth muscle strip contraction at time points from 0 h to 7 days after AUR were estimated by cystometric and organ bath studies. Hsp27 expression in bladder tissue at each time point was detected with immunofluorescence, Western blots, and real-time PCR. Expression of the three phosphorylated forms of Hsp27 was detected by Western blots. Smooth muscle ultrastructure was observed by transmission electron microscopy. Data suggest that maximum detrusor pressure and both carbachol-induced and spontaneous detrusor strip contraction amplitude decreased gradually for the duration from 0 to 6 h, and then increased gradually to near-normal values at 24 h. Treatment of muscle strips with the p38MAK inhibitor, SB203580, inhibited carbachol-induced contractions. Smooth muscle ultrastructure damage was the highest at 6 h after AUR, and then lessened gradually during next 7 days, and ultrastructure was close to normal. Expressions of Hsp27 mRNA and protein and the proteins of the three phosphorylated forms were higher at 0 h, decreased to lower levels up to 6 h, and then gradually increased. Therefore, we conclude that rat bladder contractile function after AUR worsens during 0-6 h, and then gradually recovers. The findings of the current study suggest that Hsp27 modulates bladder smooth muscle contraction after AUR, and that phosphorylation of Hsp27 may be an important pathway modulating actin cytoskeleton dynamics in bladder smooth muscle contraction and reconstruction after injury.

The incidence of acute urinary retention secondary to BPH is increasing among California men.

PubMed

Groves, H K; Chang, D; Palazzi, K; Cohen, S; Parsons, J K

2013-09-01

Current epidemiological patterns of adverse events of clinical BPH remain unclear. We investigated trends in acute urinary retention (AUR) associated with BPH in a large, population-based cohort. We utilized the California Office of Statewide Health Planning and Development Database to examine 3 724 016 emergency room (ER) visits in California among men aged  50 years from 2007 to 2010. Outcomes included AUR for which BPH was the primary diagnosis, AUR for which BPH was a secondary diagnosis and urethral catheterization for AUR. We generated adjusted odds ratios (ORadj) using multivariate logistic regression to determine longitudinal trends. A total of 17 023 men presented with a diagnosis of BPH-associated AUR, the unadjusted incidence of which increased from 4.00 per 1000 ER visits in 2007 to 5.23 per 1000 ER visits in 2010 (P<0.001). In adjusted analyses, primary AUR (ORadj=1.25; 95% confidence interval (CI), 1.19-1.32; P<0.001) and secondary AUR (ORadj=1.80; 95% CI, 1.62-2.00; P<0.001) increased 25% and 80%, respectively. Urethral catheterization for primary (ORadj=1.30; 95% CI, 1.22-1.39; P<0.001) and secondary (ORadj=1.82; 95% CI, 1.57-2.11; P<0.001) AUR increased 30% and 82%, respectively. Asian race (P<0.001), Hispanic race (P<0.001) and commercial insurance (P<0.001) were associated with significantly increased risks of AUR and urethral catheterization. Between 2007 and 2010, the observed incidence of BPH-associated AUR increased substantially in a large and ethnically diverse male population of the United States.

Impact of equol-producing capacity and soy-isoflavone profiles of supplements on bone calcium retention in postmenopausal women: a randomized crossover trial12

PubMed Central

Pawlowski, Jessica W; Martin, Berdine R; McCabe, George P; McCabe, Linda; Jackson, George S; Peacock, Munro; Barnes, Stephen; Weaver, Connie M

2015-01-01

Background: Postmenopausal estrogen depletion is a major contributing factor to bone loss. Soy isoflavones have variable effects on the prevention of postmenopausal bone loss, which is possibly related to the specific isoflavone content or the variable equol-producing capacity of individuals. Objective: We aimed to determine the effects of the content of isoflavones in a soy supplement and the equol-producing ability of the individual on postmenopausal bone calcium retention. Design: The study was a blinded, randomized, crossover intervention trial in 24 postmenopausal women who were prescreened for their ability to convert daidzein to equol. Women were equilibrated with 41Ca before the intervention. Interventions were 5 soy isoflavone oral supplements (2 doses of a genistein-rich soy supplement and 3 doses of mixed isoflavones in various proportions) and a bisphosphonate (risedronate). Each intervention was given sequentially for 50 d followed by a 50-d washout period. The percentage of bone calcium retention was determined from the change in urinary 41Ca:calcium. Results: Interventions that ranged from 52 to 220 mg total isoflavones/d increased bone calcium retention between 3.4% and 7.6% (P < 0.05), which was a moderate effect compared with that of risedronate at 15.3% (95% CI: 7.1%, 22.7%; P = 0.0014). The most-effective soy intervention delivered 105.23 mg total isoflavones/d as genistein, daidzein, and glycitein in their natural ratios and increased bone calcium retention by 7.6% (95% CI: 4.9%, 10.2%; P < 0.0001). Genistein, at 52.85 mg/d, increased bone calcium retention by 3.4% (95% CI: 0.5%, 6.2%; P = 0.029); but there was no benefit at higher amounts (113.52 mg/d). There was no difference (P = 0.5) in bone calcium retention between equol producers and nonproducers. Conclusion: Soy isoflavones, although not as potent as risedronate, are effective bone-preserving agents in postmenopausal women regardless of their equol-producing status, and mixed isoflavones in their natural ratios are more effective than enriched genistein. This trial was registered at clinicaltrials.gov as NCT00244907. PMID:26245807

Retention of African American Women in a Lifestyle Physical Activity Program

PubMed Central

Buchholz, Susan W.; Wilbur, JoEllen; Schoeny, Michael E.; Fogg, Louis; Ingram, Diana M.; Miller, Arlene; Braun, Lynne

2015-01-01

Using a cohort of African American women enrolled in a physical activity program, the purpose of the paper is to examine how well individual characteristics, neighborhood characteristics and intervention participation predict study retention and staff level of effort needed for retention. Secondary data analysis was conducted from a randomized clinical trial. Participants were 40–65 years without major signs/symptoms of cardiovascular disease. Assessments were conducted at community sites in/bordering African American communities. Study retention was 90%. Of those retained, 24% required moderate/high level of staff effort for retention. Retention was predicted by being older, having lower perceived neighborhood walkability, living in neighborhoods with greater disadvantage and crime, and having greater program participation. More staff effort was predicted by participants being younger, having more economic hardships, poorer health, or lower intervention participation. We may be able to identify people at baseline likely to require more staff effort to retain. PMID:26475680

Variability of urinary salt excretion estimated by spot urine in treated hypertensive patients.

PubMed

Arakawa, Kimika; Sakaki, Minako; Sakata, Satoko; Oniki, Hideyuki; Tominaga, Mitsuhiro; Tsuchihashi, Takuya

2015-01-01

Among the several methods used to assess salt intake, estimating 24 h urinary salt excretion by spot urine seems appropriate for clinical practice. In this study, we investigated variability in urinary salt excretion using spot urine in hypertensive outpatients. Participants included 200 hypertensive patients who underwent spot urinary salt excretion at least three times during the observation period. Mean urinary salt excretion and the coefficient of the variation were 8.62 ± 1.96 g/day and 19.0 ± 10.2%, respectively. In the analysis of participants who underwent assessment of urinary salt excretion at least eight times (n = 54), a significant reduction in mean urinary salt excretion was found at the 5th measurement. On the contrary, the coefficient of the variation of urinary salt excretion continued to increase until the 5th measurement, and became stable thereafter. Mean urinary salt excretion was positively correlated with mean clinic diastolic blood pressure (r = 0.27, p < 0.05). Clinic diastolic blood pressure in the high urinary salt excretion group (≥ 10 g/day) was significantly higher than that of the low group (76.2 ± 7.5 vs 73.4 ± 8.3 mmHg, p < 0.05). Mean urinary salt excretion in summer was significantly lower than that of the other seasons (7.75 ± 1.94 vs 9.09 ± 2.68 (spring), 8.72 ± 2.12 (autumn), 8.92 ± 2.17 (winter) g/day, p < 0.01). In conclusion, repeated measurements of urinary salt excretion using spot urine are required to assess daily salt intake of hypertensive patients.

Urinary conduits in gynecologic oncology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hancock, K.C.; Copeland, L.J.; Gershenson, D.M.

1986-05-01

Over an 11-year period (1971 to 1981), 212 urinary conduit surgeries were performed by the Department of Gynecology at the University of Texas, M. D. Anderson Hospital and Tumor Institute at Houston. The urinary diversions were performed as part of the pelvic exenteration operation in 154 patients, for radiation injury in 48 patients, and for palliation of disease recurrence in ten patients. Ninety-three percent had prior pelvic radiotherapy. Various segments of the gastrointestinal tract were used, including the ileum (102), sigmoid colon (99), transverse colon (four), jejunum (four), and others (three). Fifty percent of abnormal preoperative intravenous pyelograms reverted tomore » normal after urinary diversion. Revision of the stoma was required in 6%. Other complications included infection (18%), renal loss (17%), and urinary leaks and fistulae (3%). The overall perioperative mortality was 7%, decreasing from 11% in the first five years to 3% during the last six years. Ureteral stents were routinely used. When selecting a segment of bowel for a urinary conduit, both tissue quality and mobility are important. Mortality and morbidity of urinary conduit surgery continues to decrease with experience.« less

Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow-up.

PubMed

Porpiglia, Francesco; Fiori, Cristian; Bertolo, Riccardo; Garrou, Diletta; Cattaneo, Giovanni; Amparore, Daniele

2015-08-01

To report the first clinical experience with a temporary implantable nitinol device (TIND; Medi-Tate(®) ) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). In all, 32 patients with LUTS were enrolled in this prospective study, which was approved by our Institutional Ethics Committee. Inclusion criteria were: age >50 years, International Prostate Symptom Score (IPSS) of ≥10, maximum urinary flow rate (Qmax ) of ≤12 mL/s, and prostate volume of <60 mL. The TIND was implanted within the bladder neck and the prostatic urethra under light sedation, using a rigid cystoscope. The device was removed 5 days later in an outpatient setting. Demographics, perioperative results, complications (according to the Clavien system), functional results and quality of life (QoL) were evaluated. Follow-up assessments were made at 3 and 6 weeks, and 3, 6 and 12 months postoperatively. The Student's t-test, analysis of variance (anova), Kruskall-Wallis test, and simple and multiple linear regression models were used in the statistical analyses. The mean patient age was 69.4 years, the mean (standard deviation, sd) prostate volume was 29.5 (7.4) mL and the Qmax was 7.6 (2.2) mL/s. The median (interquartile range, IQR) IPSS was 19 (14-23) and QoL score was 3 (3-4). All the implantations were successful, with no intraoperative complications recorded. The mean operative time (sd) was 5.8 (2.5) min and the median (IQR) postoperative stay was 1 (1-2) day. All but one of the devices (96%) was removed 5 days at after implantation in an outpatient setting. Four complications (12.5%) were recorded, including urinary retention (one, 3.1%), transient incontinence due to device displacement (one, 3.1%), prostatic abscess (one, 3.1%), and urinary tract infection (one, 3.1%). Multiple regression analysis failed to identify any independent prognostic factor for complications. There were statistically significant differences in the IPSS, QoL score and Qmax when comparing pre- and postoperative results at every time point. After 12 months, the median (IQR) IPSS and QoL score were 9 (7-13) and 1 (1-2), respectively, and the mean (sd) Qmax was 12 (4.7) mL/s. The mean variations with respect to baseline conditions at the same time points were -45% for the IPSS and +67% for Qmax . At 12 months after surgery (last follow-up visit), no patients required medical therapy or surgical procedures for BPH. TIND implantation is a feasible and safe minimally invasive option for the treatment of BPH-related LUTS. The functional results are encouraging and the treatment significantly improved patient QoL. Further studies are required to assess durability of TIND results and to optimise the indications of such a procedure. © 2014 The Authors BJU International © 2014 BJU International Published by John Wiley & Sons Ltd.

TVT and TVT-O for surgical treatment of primary stress urinary incontinence: prospective randomized trial.

PubMed

Krofta, Ladislav; Feyereisl, Jaroslav; Otcenásek, Michal; Velebil, Petr; Kasíková, Eva; Krcmár, Michal

2010-02-01

A study was conducted to compare the efficacy and complications of TVT and TVT-O. This study is a prospective randomized trial involving 300 women with primary SUI; 149 received TVT, and 151 patients were treated with TVT-O. At the 1 year follow-up, 141 TVT patients and 147 TVT-O patients (dropout, 5.3% and 2.6%) were evaluated using urodynamic studies, validated questionnaires, and a 1-h pad test. The mean operating time was shorter in the TVT-O group (p < 0.001). Urinary retention was not significantly different (p > 0.05). Inner thigh discomfort was reported by 5.4% of TVT-O patients. In the TVT and the TVT-O groups, respectively, 90.1% and 88.4% women were objectively cured. The satisfaction with the surgical outcome reflects the significant decrease in the questionnaire mean symptom scores in both groups. Postoperative de novo urgency was significantly more common in the TVT-O patients (p = 0.015). The groups showed comparable objective and subjective cure rates.

Salvage cryotherapy for recurrent prostate cancer after radiation failure: a prospective case series of the first 100 patients.

PubMed

Ismail, Mohamed; Ahmed, Shwan; Kastner, Christof; Davies, John

2007-10-01

To report the short- to intermediate-term experience of using salvage targeted cryoablation of the prostate (TCAP) for the recurrence of localized prostate cancer after radiotherapy. Between May 2000 and November 2005, 100 patients had salvage TCAP for recurrent prostate cancer after radiotherapy; the mean follow-up was 33.5 months. All patients had biopsy-confirmed recurrent prostate cancer. Biochemical recurrence-free survival (BRFS) was defined using a prostate specific antigen (PSA) level of <0.5 ng/mL and by applying the American Society for Therapeutic Radiology and Oncology (ASTRO) definition for biochemical failure. Patients were stratified into three risk groups, i.e. high-risk (68 men), intermediate-risk (20) and low-risk (12). There were no operative or cancer-related deaths; the 5-year actuarial BRFS was 73%, 45% and 11% for the low-, intermediate- and high-risk groups, respectively. Complications included incontinence (13%), erectile dysfunction (86%), lower urinary tract symptoms (16%), prolonged perineal pain (4%), urinary retention (2%), and recto-urethral fistula (1%). Salvage TCAP is a safe and effective treatment for localized prostate cancer recurrence after radiotherapy.

Medical Therapy for Benign Prostatic Hyperplasia: New Terminology, New Concepts, Better Choices

PubMed Central

Kaplan, Steven A

2006-01-01

This article discusses 3 areas of medical therapy for benign prostatic hyperplasia (BPH) that are undergoing extensive research and evaluation: 1) the use of muscarinic receptor antagonists to treat lower urinary tract symptoms (LUTS) in men with BPH; 2) the definition of an “enlarged prostate”; and 3) sexual function and LUTS. Fears of worsening obstructive symptoms or causing acute urinary retention often keep practitioners from prescribing muscarinic receptor antagonists to men who might have concomitant bladder outlet obstruction; a multicenter, multinational, double-blind study showed that tolterodine is safe for men with low postvoid residual volumes. Most urologists accept that a prostate volume of more than 40 mL is consistent with an enlarged prostate; there is more debate regarding prostate volumes of 30 to 40 mL. Recently presented data suggest that combination medical therapy might be effective for men having prostates with volumes of more than 25 mL. The association between voiding and sexual function has been increasingly recognized and investigated, and there seem to be common pathophysiologic mechanisms governing both conditions. Targeted treatment algorithms addressing both conditions seem warranted. PMID:16985556

Diagnosis and management of urinary tract infections in the emergency department.

PubMed

Best, Jessica; Kitlowski, Andrew David; Ou, Derek; Bedolla, John

2014-07-01

Urinary tract infections are a heterogeneous group of disorders, involving infection of all or part of the urinary tract, and are defined by bacteria in the urine with clinical symptoms that may be acute or chronic. Approximately 1 million urinary tract infections are treated every year in United States emergency departments. The female-to-male ratio is 6:1. Urinary tract infections are categorized as upper versus lower tract involvement and as uncomplicated versus complicated. The emergency clinician must carefully categorize the infection and take into account patient host factors to optimally treat and disposition patients. A working knowledge of local or at least national susceptibility patterns of the most likely pathogens is essential. A variety of special populations exist that require special management, including pregnant females, patients with anatomic abnormalities, and instrumented patients.

[Lower urinary tract dysfunction and neuropathological findings of the neural circuits controlling micturition in familial amyotrophic lateral sclerosis with L106V mutation in the SOD1 gene].

PubMed

Hineno, Akiyo; Oyanagi, Kiyomitsu; Nakamura, Akinori; Shimojima, Yoshio; Yoshida, Kunihiro; Ikeda, Shu-Ichi

2016-01-01

We report lower urinary tract dysfunction and neuropathological findings of the neural circuits controlling micturition in the patients with familial amyotrophic lateral sclerosis having L106V mutation in the SOD1 gene. Ten of 20 patients showed lower urinary tract dysfunction and 5 patients developed within 1 year after the onset of weakness. In 8 patients with an artificial respirator, 6 patients showed lower urinary tract dysfunction. Lower urinary tract dysfunction and respiratory failure requiring an artificial respirator occurred simultaneously in 3 patients. Neuronal loss and gliosis were observed in the neural circuits controlling micturition, such as frontal lobe, thalamus, hypothalamus, striatum, periaqueductal gray, ascending spinal tract, lateral corticospinal tract, intermediolateral nucleus and Onufrowicz' nucleus. Lower urinary tract dysfunction, especially storage symptoms, developed about 1 year after the onset of weakness, and the dysfunction occurred simultaneously with artificial respirator use in the patients.

Diagnosis and management of urinary incontinence and functional fecal incontinence (encopresis) in children.

PubMed

Nijman, Rien J M

2008-09-01

The ability to maintain normal continence for urine and stools is not achievable in all children by a certain age. Gaining control of urinary and fecal continence is a complex process, and not all steps and factors involved are fully understood. While normal development of anatomy and physiology are prerequisites to becoming fully continent, anatomic abnormalities, such as bladder exstrophy, epispadias, ectopic ureters, and neurogenic disturbances that can usually be recognized at birth and cause incontinence, will require specialist treatment, not only to restore continence but also to preserve renal function. Most forms of urinary incontinence are not caused by an anatomic or physiologic abnormality and, hence, are more difficult to diagnose and their management requires a sound knowledge of bladder and bowel function.

The visual and radiological inspection of a pipeline using a teleoperated pipe crawler

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fogle, R.F.; Kuelske, K.; Kellner, R.

1995-01-01

In the 1950s, the Savannah River Site built an open, unlined retention basin to temporarily store potentially radionuclide contaminated cooling water from a chemical separations process and storm water drainage from a nearby waste management facility that stored large quantities of nuclear fission byproducts in carbon steel tanks. The retention basin was retired from service in 1972 when a new, lined basin was completed. In 1978, the old retention basin was excavated, backfilled with uncontaminated dirt, and covered with grass. At the same time, much of the underground process pipeline leading to the basin was abandoned. Since the closure ofmore » the retention basin, new environmental regulations require that the basin undergo further assessment to determine whether additional remediation is required. A visual and radiological inspection of the pipeline was necessary to aid in the remediation decision making process for the retention basin system. A teleoperated pipe crawler inspection system was developed to survey the abandoned sections of underground pipelines leading to the retired retention basin. This paper will describe the background to this project, the scope of the investigation, the equipment requirements, and the results of the pipeline inspection.« less

The inspection of a radiologically contaminated pipeline using a teleoperated pipe crawler

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fogle, R.F.; Kuelske, K.; Kellner, R.A.

1995-08-01

In the 1950s, the Savannah River Site built an open, unlined retention basin to temporarily store potentially radionuclide contaminated cooling water from a chemical separations process and storm water drainage from a nearby waste management facility that stored large quantities of nuclear fission byproducts in carbon steel tanks. The retention basin was retired from service in 1972 when a new, lined basin was completed. In 1978, the old retention basin was excavated, backfilled with uncontaminated dirt, and covered with grass. At the same time, much of the underground process pipeline leading to the basin was abandoned. Since the closure ofmore » the retention basin, new environmental regulations require that the basin undergo further assessment to determine whether additional remediation is required. A visual and radiological inspection of the pipeline was necessary to aid in the remediation decision making process for the retention basin system. A teleoperated pipe crawler inspection system was developed to survey the abandoned sections of underground pipelines leading to the retired retention basin. This paper will describe the background to this project, the scope of the investigation, the equipment requirements, and the results of the pipeline inspection.« less

5 CFR 575.312 - Internal monitoring requirements and revocation or suspension of authority.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Internal monitoring requirements and... MANAGEMENT CIVIL SERVICE REGULATIONS RECRUITMENT, RELOCATION, AND RETENTION INCENTIVES; SUPERVISORY DIFFERENTIALS; AND EXTENDED ASSIGNMENT INCENTIVES Retention Incentives § 575.312 Internal monitoring...

29 CFR 1904.33 - Retention and updating.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR RECORDING AND REPORTING OCCUPATIONAL INJURIES AND ILLNESSES Other OSHA Injury and Illness Recordkeeping Requirements § 1904.33 Retention and updating. (a) Basic requirement. You must save the OSHA 300 Log, the...

29 CFR 1904.33 - Retention and updating.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR RECORDING AND REPORTING OCCUPATIONAL INJURIES AND ILLNESSES Other OSHA Injury and Illness Recordkeeping Requirements § 1904.33 Retention and updating. (a) Basic requirement. You must save the OSHA 300 Log, the...

Urinary and faecal N-methylhistamine concentrations do not serve as markers for mast cell activation or clinical disease activity in dogs with chronic enteropathies.

PubMed

Anfinsen, Kristin P; Berghoff, Nora; Priestnall, Simon L; Suchodolski, Jan S; Steiner, Jörg M; Allenspach, Karin

2014-12-21

This study sought to correlate faecal and urinary N-methylhistamine (NMH) concentrations with resting versus degranulated duodenal mast cell numbers in dogs with chronic enteropathies (CE), and investigate correlations between intestinal mast cell activation and clinical severity of disease as assessed by canine chronic enteropathy clinical activity index (CCECAI), and between urinary and faecal NMH concentrations, mast cell numbers, and histopathological scores. Twenty-eight dogs with CE were included. Duodenal biopsies were stained with haematoxylin and eosin (H&E), toluidine blue, and by immunohistochemical labelling for tryptase. Duodenal biopsies were assigned a histopathological severity score, and duodenal mast cell numbers were counted in five high-power fields after metachromatic and immunohistochemical staining. Faecal and urinary NMH concentrations were measured by gas chromatography-mass spectrometry. There was no correlation between the CCECAI and faecal or urinary NMH concentrations, mast cell numbers, or histopathological score - or between faecal or urinary NMH concentration and mast cell numbers. Post hoc analysis revealed a statistically significant difference in toluidine blue positive mast cells between two treatment groups (exclusion diet with/without metronidazole versus immunosuppression (IS)), with higher numbers among dogs not requiring IS. Faecal and urinary NMH concentrations and duodenal mast cell numbers were not useful indicators of severity of disease as assessed by the CCECAI or histological evaluation. The number of duodenal mast cells was higher in dogs that did not need IS, i.e. in dogs responding to an exclusion diet (with/without metronidazole), than in dogs requiring IS. Further studies comparing the role of mast cells in dogs with different forms of CE are needed.

Anorectal emergencies

PubMed Central

Lohsiriwat, Varut

2016-01-01

Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up. PMID:27468181

Results of surgical excision of urethral prolapse in symptomatic patients.

PubMed

Hall, Mary E; Oyesanya, Tola; Cameron, Anne P

2017-11-01

Here, we present the clinical presentation and surgical outcomes of women with symptomatic urethral prolapse presenting to our institution over 20 years, and seek to provide treatment recommendations for management of symptomatic urethral prolapse and caruncle. A retrospective review of medical records from female patients who underwent surgery for symptomatic urethral prolapse from June 1995 to August 2015 was performed. Surgical technique consisted of a four-quadrant excisional approach for repair of urethral prolapse. A total of 26 patients were identified with a mean age of 38.8 years (range 3-81). The most common presentations were vaginal bleeding, hematuria, pain, and dysuria. All patients underwent surgical excision of urethral prolapse via a standard approach. Follow-up data was available in 24 patients. Six patients experienced temporary postoperative bleeding, and one patient required placement of a Foley catheter for tamponade. One patient experienced temporary postoperative urinary retention requiring Foley catheter placement. Three patients had visible recurrence of urethral prolapse, for which one later underwent re-excision. Surgical excision of urethral prolapse is a reasonable treatment option in patients who have tried conservative management without relief, as well as in those who present with severe symptoms. Possible complications following excision include postoperative bleeding and recurrence, and patients must be counseled accordingly. In this work, we propose a treatment algorithm for symptomatic urethral prolapse. © 2017 Wiley Periodicals, Inc.

[Prostatic localization revealing an acute myeloid leukemia. Apropos of a case].

PubMed

Smaoui, S; Lecomte, M J; Peraldi, R; Pernin, F

1998-09-01

The authors report an original case of acute myeloid leukaemia (AML) presenting in the form of acute urinary retention, confirmed by prostatic biopsy, with complete absence of any non-urological clinical features. Prostatic sites of leukaemia are frequent and classically reported, but often occur during the course of known leukaemia, and are rarely symptomatic, justifying biopsies in the presence of any prostatic symptoms. Immunolabelling represents the key to the diagnosis in the presence of undifferentiated cells demonstrated on prostatic biopsies. The outcome was fatal in this case, despite early chemotherapy. The clinical features, clinical course and therapeutic aspects of prostatic leukaemia are discussed.

Toxicodynamic and toxicokinetic descriptors of combined chromium (VI) and nickel toxicity.

PubMed

Minigaliyeva, Ilzira A; Katsnelson, Boris A; Privalova, Larisa I; Gurvich, Vladimir B; Panov, Vladimir G; Varaksin, Anatoly N; Makeyev, Oleg H; Sutunkova, Marina P; Loginova, Nadezhda V; Kireyeva, Ekaterina P; Grigoryeva, Ekaterina V; Slyshkina, Tatyana V; Ganebnykh, Eugenia V; Grebenkina, Svetlana V

2014-01-01

After repeated intraperitoneal injections of nickel and chromium (VI) salts to rats, we found, and confirmed by mathematical modeling, that their combined subchronic toxicity can either be of additive type or depart from it (predominantly toward subadditivity) depending on the effect assessed. Against the background of moderate systemic toxicity, the combination under study proved to possess a marked additive genotoxicity assessed by means of the random amplification of polymorphic DNA test. We also demonstrated that chromium and nickel reciprocally influenced the retention of these metals in some organs (especially in the spleen) but not their urinary excretion in this study. © The Author(s) 2014.

Urinary morbidity following ultrasound-guided transperineal prostate seed implantation.

PubMed

Gelblum, D Y; Potters, L; Ashley, R; Waldbaum, R; Wang, X H; Leibel, S

1999-08-01

To assess the urinary morbidity experienced by patients undergoing ultrasound-guided, permanent transperineal seed implantation for adenocarcinoma of the prostate. Between September 1992 and September 1997, 693 consecutive patients presented with a diagnosis of clinically localized adenocarcinoma of the prostate, and were treated with ultrasound-guided transperineal interstitial permanent brachytherapy (TPIPB). Ninety-three patients are excluded from this review, having received neoadjuvant antiandrogen therapy. TPIPB was performed with 125I in 165 patients and with 103Pd in 435 patients. Patients treated with implant alone received 160 Gy with 125I (pre TG43) or 120 Gy with 103Pd. One hundred two patients received preimplant, pelvic external beam radiation (XRT) to a dose of either 41.4 or 45 Gy because of high-risk features including PSA > or = 10 and/or Gleason score > or = 7. Combined modality patients received 120 Gy and 90 Gy, respectively for 125I or 103Pd. All patients underwent postimplant cystoscopy and placement of an indwelling Foley catheter for 24-48 h. Follow-up was at 5 weeks after implant, every 3 months for the first 2 years, and then every 6 months for subsequent years. Patients completed AUA urinary symptom scoring questionnaires at initial consultation and at each follow-up visit. Urinary toxicity was classified by the RTOG toxicity scale with the following adaptations; grade 1 urinary toxicity was symptomatic nocturia or frequency requiring none or minimal medical intervention such as phenazopyridine; grade 2 urinary toxicity was early obstructive symptomatology requiring alpha-blocker therapy; and grade 3 toxicity was considered that requiring indwelling catheters or posttreatment transurethral resection of the prostate for symptom relief. Log-rank analysis and Chi-square testing was performed to assess AUA score, prostate size, isotope selection, and the addition of XRT as possible prognosticators of postimplant urinary toxicity. The prostate volume receiving 150% of the prescribed dose (V150) was studied in patients to assess its correlation with urinary toxicity. Median follow-up was 37 months (range 6-68). Within the first 60 days, 37.3% of the patients reported grade 1 urinary toxicity, 41% had grade 2, and 2.2% had grade 3 urinary toxicity. By 6 months, 21.4% still reported grade 1 urinary toxicity, whereas 12.8% and 3% complained of grade 2 and 3 urinary difficulties, respectively. Patients with a preimplant AUA score < or = 7 had significantly less grade II toxicity at 60 days compared to those with an AUA score of >7 (32% vs. 59.2%, respectively, p = 0.001). Similarly, prostatic volumes < or = 35 cc had a significantly lower incidence of grade II urinary toxicity (p = 0.001). There was no difference in toxicity regarding the isotope used (p = 0.138 at 60 days, p = 0.45 at 6 months) or the addition of preimplant XRT (p = 0.069 at 60 days, p = 0.84 at 6 months). Twenty-eight patients (4.7%) underwent TURP after 3 isotope half-lives for protracted obstructive symptoms. Five of these men (17%) developed stress incontinence following TURP, but all patients experienced relief of their obstructive symptoms without morbidity at last follow-up. The percent of the prostate receiving 150% of the prescribed dose (V150) did not predict urinary toxicity. TPIPB is well tolerated but associated with mild to moderate urinary morbidity. Pretreatment prostatic volume and AUA scoring were shown to significantly predict for grade 2 toxicity while the use of preimplant, pelvic XRT and isotope selection did not. Patients undergoing TURP for protracted symptoms following TPIPB did well with a 17% risk of developing stress incontinence. V150 did not help identify patients at risk for urinary morbidity. As transperineal prostate implantation is used more frequently the associated toxicities and the definition of possible pretreatment prognostic factors is necessary to

The Urinary Tract Microbiome in Health and Disease.

PubMed

Aragón, Isabel M; Herrera-Imbroda, Bernardo; Queipo-Ortuño, María I; Castillo, Elisabeth; Del Moral, Julia Sequeira-García; Gómez-Millán, Jaime; Yucel, Gozde; Lara, María F

2016-11-14

The urinary tract, previously considered a sterile body niche, has emerged as the host of an array of bacteria in healthy individuals, revolutionizing the urology research field. To review the literature on microbiome implications in the urinary tract and the usefulness of probiotics/prebiotics and diet as treatment for urologic disorders. A systematic review was conducted using PubMed and Medline from inception until July 2016. The initial search identified 1419 studies and 89 were included in this systematic review. Specific bacterial communities have been found in the healthy urinary tract. Changes in this microbiome have been observed in certain urologic disorders such as urinary incontinence, urologic cancers, interstitial cystitis, neurogenic bladder dysfunction, sexually transmitted infections, and chronic prostatitis/chronic pelvic pain syndrome. The role of probiotics, prebiotics, and diet as treatment or preventive agents for urologic disorders requires further investigation. There is a microbiome associated with the healthy urinary tract that can change in urologic disorders. This represents a propitious context to identify new diagnostic, prognostic, and predictive microbiome-based biomarkers that could be used in clinical urology practice. In addition, probiotics, prebiotics, and diet modifications appear to represent an opportunity to regulate the urinary microbiome. We review the urinary microbiome of healthy individuals and its changes in relation to urinary disorders. The question to resolve is how we can modulate the microbiome to improve urinary tract health. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Effect of pelvic floor muscle exercise programme on stress urinary incontinence among pregnant women.

PubMed

Sangsawang, Bussara; Serisathien, Yaowalak

2012-09-01

This article is a report of a study of the effects of a pelvic floor muscle exercise programme on the severity of stress urinary incontinence in pregnant women. Pregnancy is main risk factor for the development of stress urinary incontinence. Stress urinary incontinence can be cured by pelvic floor muscle exercise which is a safe inexpensive treatment with no complications and does not require the use of instruments. A quasi-experimental study, pre-post test with control group design was used at the antenatal care unit in a tertiary care hospital between June and October of 2006. The participants were 66 pregnant women who had stress urinary incontinence with gestational ages of 20-30 weeks. The main outcome measure was severity of stress urinary incontinence which comprised frequency and amount of urine leakage and perceived severity of stress urinary incontinence. After the experimental group's participation in the pelvic floor muscle exercise programme, the frequency and amount of urine leakage and the score of perceived stress urinary incontinence severity were significantly lower than the same scores before participation in the programme. In addition, women in the experimental group had frequency and volume of urine leakage, and score of perceived stress urinary incontinence severity after participation significantly lower than those in the control group. The 6-week pelvic floor muscle exercise programme was able to decrease the severity of symptoms in pregnant women with stress urinary incontinence. © 2011 Blackwell Publishing Ltd.

29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 9 2014-07-01 2014-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 9 2011-07-01 2011-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 9 2012-07-01 2012-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 9 2013-07-01 2013-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

Health-related quality of life and mental health in older women with urinary incontinence.

PubMed

Kwak, YeunHee; Kwon, HaeJin; Kim, YoonJung

2016-07-01

The purpose of this cross-sectional study was to compare health-related quality of life (QOL) and mental health between older women with and without urinary incontinence. This study is a secondary data analysis using raw data from 1874 women aged 65 years or older who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) IV (2008-2009), a nationally representative sample. In the pain/discomfort dimension of the EuroQol-5, 25.4% of the participants experienced urinary incontinence and 14.7% did not (p = .001). In the anxiety/depression dimension, urinary incontinence was present in 8.3% of the participants and absent in 3.6% (p = 0.012). In addition, the results of an ANCOVA showed that scores in both the EuroQol visual analogue scale and the EQ-5D index were significantly lower in participants with urinary incontinence relative to those without. The risk of stress and depression in older women with urinary incontinence was approximately 2 and 1.5 times higher, respectively, than that of participants without urinary incontinence. Health-related QOL in older women with urinary incontinence was relatively low, while levels of stress and depression were high. Therefore, in order to improve QOL and mental health in older women, the understanding and management of urinary incontinence interventions is required.

Prevalence of symptomatic urinary calculi in Kerman, Iran.

PubMed

Ketabchi, Ali Asghar; Aziziolahi, Gholam Abbas

2008-01-01

In a cross-sectional study, we evaluated the prevalence of symptomatic urinary calculi in Kerman, Iran. A total of 2431 citizens of Kerman were surveyed from September of 2005 to April 2006. The study population was selected by cluster method from 5 different areas, and 100 houses in each area were randomly approached. Questions on the urinary symptoms consisted of flank pain, urogenital pain, dysuria or any difficulty in urination, and alterations in urine color. Individuals with a suspicion of urinary calculi based on their symptoms were evaluated by physical examination, laboratory investigations, and plain abdominal radiography. Ultrasonography and intravenous urography were done if required to confirm the diagnoses. Of 2431 individuals, 196 (8.1%) had symptoms in favor of urinary calculus diagnosis, of whom 47 (24.0%) had urinary calculi (prevalence of symptomatic urolithiasis was 1.9%). Of the patients, 35 (74.5%) were underweight. Compared to the other participants, the patients with urinary calculus were younger (P = .001) and a larger proportion of them had a positive family history of urinary calculi (14.9% versus 6.5%; P = .02) and were rug weavers and office employees. Dependency on opium and its derivative was significantly more frequent in patients with urinary calculi (25.5% versus 0.2%; P = .001). This study showed that the prevalence of symptomatic urinary calculi in this hot and dry area is relatively high. According to our findings, the other factors including specific occupations, malnutrition, and substance use may also have influence on the rate of urinary calculus formation. Therefore, to prevention and early treatment of urinary calculi, evaluation of potential predisposing conditions should be considered with special attention to regional factors.

Requirement for specific gravity and creatinine adjustments for urinary steroids and luteinizing hormone concentrations in adolescents.

PubMed

Singh, Gurmeet K S; Balzer, Ben W R; Desai, Reena; Jimenez, Mark; Steinbeck, Katharine S; Handelsman, David J

2015-11-01

Urinary hormone concentrations are often adjusted to correct for hydration status. We aimed to determine whether first morning void urine hormones in growing adolescents require adjustments and, if so, whether urinary creatinine or specific gravity are better adjustments. The study population was adolescents aged 10.1 to 14.3 years initially who provided fasting morning blood samples at 0 and 12 months (n = 343) and first morning urine every three months (n = 644). Unadjusted, creatinine and specific gravity-adjusted hormonal concentrations were compared by Deming regression and Bland-Altman analysis and grouped according to self-rated Tanner stage or chronological age. F-ratios for self-rated Tanner stages and age groups were used to compare unadjusted and adjusted hormonal changes in growing young adolescents. Correlations of paired serum and urinary hormonal concentration of unadjusted and creatinine and specific gravity-adjusted were also compared. Fasting first morning void hormone concentrations correlated well and were unbiased between unadjusted or adjusted by either creatinine or specific gravity. Urine creatinine concentration increases with Tanner stages, age and male gender whereas urine specific gravity was not influenced by Tanner stage, age or gender. Adjustment by creatinine or specific gravity of urinary luteinizing hormone, estradiol, testosterone, dihydrotestosterone and dehydroepiandrosterone concentrations did not improve correlation with paired serum concentrations. Urine steroid and luteinizing hormone concentrations in first morning void samples of adolescents are not significantly influenced by hydration status and may not require adjustments; however, if desired, both creatinine and specific gravity adjustments are equally suitable. © The Author(s) 2015.

47 CFR 73.1212 - Sponsorship identification; list retention; related requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 4 2011-10-01 2011-10-01 false Sponsorship identification; list retention; related requirements. 73.1212 Section 73.1212 Telecommunication FEDERAL COMMUNICATIONS COMMISSION... network, the list may, instead, be retained at the headquarters office of the network or at the location...

[Trans-obturator urethral sling for surgical correction of female stress urinary incontinence: Outside-in (Monarc) versus inside-out (TVT-O). Are both ways safe?].

PubMed

Debodinance, P

2006-10-01

The originally described outside-in procedure for the trans-obturator route was later turned inside-out. We wanted to demonstrate the safety of the two techniques through personal and published experience. Non-randomized, prospective, observational, open-label, longitudinal study of 100 female patients (50 TVT-O and 50 Monarc). All the female patients presented with isolated stress urinary incontinence. Only 4 patients presented with mixed incontinence in the Monarc (MON) group. Sphincter incompetence was observed 4 times in the MON group and 3 times in the TVT-O group. All the patients underwent surgery under assisted local anesthesia in a day-hospital setting. Only those patients presenting with patent established urinary incontinence, corrected by the TVT test, underwent surgery. Post-operative control was conducted at 3 months and 1 year. The duration of hospitalization was 10 h for 48 patients in the MON group and 49 in the TVTO group. The only per-operative complication was a vaginal perforation in the lateral angle of the vagina for a MON patient. Early post-operative complications were observed in the MON group: 3 cases of urinary tract infection, 1 of transient urine retention, 3 of pain in the thighs spontaneously resolving within 4 days and 1 of permanent pain in one leg at time 1 year, which remained bearable. For the TVTO group the post-operative complications consisted in: 1 case of urinary tract infection, 1 of transient retention and 4 of pain in the thigh. No hematoma was reported in either group. Among the late complications, the de novo symptoms included 1 case of imperious urges to urinate in the TVTO group and objective dysuria in 2 cases in the MON group vs. 7 in the TVTO group. There was no statistically significant between-group difference in the complications. No tape exposure was observed. Overall, the recovery rate was 90% at 1 year for MON vs. 94% for TVTO (p = NS) with 2 cases of recurrence between 3 months and 1 year in that series. Mixed incontinence was corrected at time point 1 year in 75% of cases for MON, with 1 case of recurrence in the year. For the patients presenting with sphincter incompetence, competence was maintained at 3 months and 1 year in all cases in the MON group. The 3 TVT-O were cured at 3 months, but 2 recurrences were observed at 1 year. All patients, except one, were satisfied at time point 1 year and those who had sexual relations (54%) did not report any disorder at time point 1 year. The cadaveric studies by advocates of the outside-in technique show a vascular and nervous risk which has received little attention in terms of complications in the literature. Post-operative leg pain is encountered with both techniques and usually is transient. Our experience, like that reported in the literature, shows that the two trans-obturator access routes are equally safe. The clinical results would appear to be equivalent, in terms of recovery, to the rates obtained with retropubic TVT.

Patient-centered recruitment and retention for a randomized controlled study.

PubMed

Chhatre, Sumedha; Jefferson, Ashlie; Cook, Ratna; Meeker, Caitlin R; Kim, Ji Hyun; Hartz, Kayla Marie; Wong, Yu-Ning; Caruso, Adele; Newman, Diane K; Morales, Knashawn H; Jayadevappa, Ravishankar

2018-03-27

Recruitment and retention strategies for patient-centered outcomes research are evolving and research on the subject is limited. In this work, we present a conceptual model of patient-centered recruitment and retention, and describe the recruitment and retention activities and related challenges in a patient-centered comparative effectiveness trial. This is a multicenter, longitudinal randomized controlled trial in localized prostate cancer patients. We recruited 743 participants from three sites over 15 months period (January 2014 to March 2015), and followed them for 24 months. At site 1, of the 773 eligible participants, 551 (72%) were enrolled. At site 2, 34 participants were eligible and 23 (68%) enrolled. Of the 434 eligible participants at site 3, 169 (39%) enrolled. We observed that strategies related to the concepts of trust (e.g., physician involvement, ensuring protection of information), communication (e.g., brochures and pamphlets in physicians' offices, continued contact during regular clinic visits and calling/emailing assessment), attitude (e.g., emphasizing the altruistic value of research, positive attitude of providers and research staff), and expectations (e.g., full disclosure of study requirements and time commitment, update letters) facilitated successful patient recruitment and retention. A stakeholders' advisory board provided important input for the recruitment and retention activities. Active engagement, reminders at the offices, and personalized update letters helped retention during follow-up. Usefulness of telephone recruitment was site specific and, at one site, the time requirement for telephone recruitment was a challenge. We have presented multilevel strategies for successful recruitment and retention in a clinical trial using a patient-centered approach. Our strategies were flexible to accommodate site-level requirements. These strategies as well as the challenges can aid recruitment and retention efforts of future large-scale, patient-centered research studies. Clinicaltrials.gov , ID: NCT02032550 . Registered on 22 November 2013.

[Post-traumatic complication of trans-appendiceal cystostomy: urinary peritonitis].

PubMed

Landry, J L; Dubois, R; Chaffange, P; Pelizzo, G; Dodat, H

2001-04-01

Two children who had undergone a transappendicular urinary diversion (type Mitrofanoff) developed bladder rupture, one following abdominal trauma, 4 months after the operation and the other following traumatic self-catheterization at 4 years. The clinical history and standard radiological examinations (ultrasonography, cystography) confirmed the diagnosis of urinary peritonitis. Emergency surgical repair was possible in both cases with an uneventful postoperative course. This serious and rare complication requires emergency surgery and justifies rigorous selection of children suitable for this type of diversion giving preference to increased bladder neck resistance over bladder neck closure.

Methodologies for the quantitative estimation of toxicant dose to cigarette smokers using physical, chemical and bioanalytical data.

PubMed

St Charles, Frank Kelley; McAughey, John; Shepperd, Christopher J

2013-06-01

Methodologies have been developed, described and demonstrated that convert mouth exposure estimates of cigarette smoke constituents to dose by accounting for smoke spilled from the mouth prior to inhalation (mouth-spill (MS)) and the respiratory retention (RR) during the inhalation cycle. The methodologies are applicable to just about any chemical compound in cigarette smoke that can be measured analytically and can be used with ambulatory population studies. Conversion of exposure to dose improves the relevancy for risk assessment paradigms. Except for urinary nicotine plus metabolites, biomarkers generally do not provide quantitative exposure or dose estimates. In addition, many smoke constituents have no reliable biomarkers. We describe methods to estimate the RR of chemical compounds in smoke based on their vapor pressure (VP) and to estimate the MS for a given subject. Data from two clinical studies were used to demonstrate dose estimation for 13 compounds, of which only 3 have urinary biomarkers. Compounds with VP > 10(-5) Pa generally have RRs of 88% or greater, which do not vary appreciably with inhalation volume (IV). Compounds with VP < 10(-7) Pa generally have RRs dependent on IV and lung exposure time. For MS, mean subject values from both studies were slightly greater than 30%. For constituents with urinary biomarkers, correlations with the calculated dose were significantly improved over correlations with mouth exposure. Of toxicological importance is that the dose correlations provide an estimate of the metabolic conversion of a constituent to its respective biomarker.

Cuminum cyminum extract attenuates scopolamine-induced memory loss and stress-induced urinary biochemical changes in rats: a noninvasive biochemical approach.

PubMed

Koppula, Sushruta; Choi, Dong Kug

2011-07-01

Cuminum cyminum Linn. (Apiaceae), cumin, is a popular spice with a long history of medicinal use to treat various symptoms such as diarrhea, flatulence, gynecological, and respiratory diseases. To date, no scientific investigation was reported regarding memory-enhancing and antistress activity of cumin fruits. The present study deals with the memory-enhancing and antistress activities and further the antioxidant status via lipid peroxidation inhibition. Antistress activity was evaluated by inducing stress via forced swimming and the urinary vanillylmandelic acid (VMA) and ascorbic acid were estimated as biomarkers. Memory-enhancing activity was studied by conditioned avoidance response using Cook's pole climbing apparatus in normal and scopolamine-induced amnestic rats. Thiobarbituric acid reactive substances (TBARS) assay was used to evaluate the lipid peroxidation. Daily administration of cumin at doses of 100, 200, and 300 mg/kg body weight 1 h prior to induction of stress inhibited the stress-induced urinary biochemical changes in a dose-dependent manner without altering the levels in normal control groups. The cognition, as determined by the acquisition, retention, and recovery in rats, was observed to be dose-dependent. The extract also produced significant lipid peroxidation inhibition in comparison with known antioxidant ascorbic acid in both rat liver and brain. This study provides scientific support for the antistress, antioxidant, and memory-enhancing activities of cumin extract and substantiates that its traditional use as a culinary spice in foods is beneficial and scientific in combating stress and related disorders.

The effects of concentrate added to pineapple (Ananas comosus Linn. Mer.) waste silage in differing ratios to form complete diets, on digestion, excretion of urinary purine derivatives and blood metabolites in growing, male, Thai swamp buffaloes.

PubMed

Jetana, T; Suthikrai, W; Usawang, S; Vongpipatana, C; Sophon, S; Liang, J B

2009-04-01

Four, male, growing Thai swamp buffaloes (197 +/- 5.3 kg and all 1 year old) were used to evaluate the effects of concentrate added to pineapple waste silage in differing ratios, to form a complete diet, studying in vivo digestion, the rate of passage, microbial protein synthesis and blood metabolites. Animals were fed ad libitum with 4 diets, using four combinations of pineapple waste silage (P) and concentrate (C), in the proportions (on a dry matter basis) of 0.8:0.2 (P80:C20), 0.6:0.4 (P60:C40), 0.4:0.6 (P40:C60) and 0.2:0.8 (P20:C80). The results showed that the intakes of dry matter (DM), organic matter (OM), nitrogen (N), the N-balance, urinary purine derivatives (PD) excretion, the ratios of allantoin to creatinine (CR), PD to CR, the plasma urea-N (PUN) and insulin increased in the animals, but the intake of neutral detergent fiber (NDF), the coefficient of whole tract, apparent digestibility of NDF, the transit time (TT) and the mean retention time (TMRT) decreased, when the proportion of concentrate in the diet increased. This study indicated that the proportion of P40:C60 in the diet produced the best efficiency of urinary PD excretion (mmol) per digestible OM intake (kg DOMI).

[Raz's technics in the surgical treatment of stress urinary incontinence in women].

PubMed

Gutiérrez Baños, J L; de Diego Rodríguez, E; Portillo Martín, J A; Martín García, B; Hernández Rodríguez, R; Correas Gómez, M A; del Valle Schaan, J I; Roca Edreira, A; Rado Velázquez, M A

1999-05-01

To analyze our results in the surgery of the stress urinary incontinence in women with the Raz's techniques, to assess the association among continence and factors like surgical technique, grade of incontinence and urethral pressure profile. We do a retrospective study of 88 operations in 81 patients between the first of January 1990 and the thirty-one of December 1998. We describe the patients, previous treatments, grade of incontinence ans urodynamics data. We analyze the pre and post-operative complications. The outcome is evaluated by the Kaplan-Meier method, and the results are compared by the log rank test. 11 patients had a previous surgery and 7 had done physiotherapy; the grade of incontinence was 1 in 7 patients, 2 in 56 and 3 in 18. There were neither significative difference between UPP and abdominal leak point pressure and grade of incontinence nor between those parameters and continence. We did the Raz 1 technique in 67 patients, Raz 2 in 3, Raz 3 in 18. There were no significant difference among them. There are a progressive loose in the continence rate along the two first years; after that the continence rates are stabilized about 75%. The complications rate was scarce, except for the postoperative urinary retention, that reached the 20.45%. Our results are similar to those cited in the bibliography, mainly in the Spanish one. The highest rate of failure is in the two first years.

Focal therapy for localized unifocal and multifocal prostate cancer: A prospective development study using real time MR guided focused ultrasound

NASA Astrophysics Data System (ADS)

Napoli, A.; Caliolo, G.; Boni, F.; Anzidei, M.; Catalano, C.

2017-03-01

To assess safety and feasibility of non-invasive high intensity 3T MR guided focused ultrasound (MRgFUS) treatment of localized prostate cancer in an exploratory designed study. Men aged 45-80 years were eligible for this prospective study if they had low-risk localized prostate cancer (prostate specific antigen [PSA] ≤10 ng/mL, Gleason score ≤ 3 + 3), with no previous androgen deprivation or treatment for prostate cancer, and who could safely undergo multiparametric MRI (Discovery 750, GE; Gd-Bopta, Bracco) and have a spinal anesthetic. Patients underwent focal therapy using real time MR guided high intensity focused ultrasound (MRgFUS), delivered to all known cancer lesions, with a margin of normal tissue. Primary endpoints were adverse events (serious and otherwise) and urinary symptoms and erectile function assessed using patient questionnaires. 8 men were recruited between June 2011 and June 2012. After treatment, one man was admitted to hospital for acute urinary retention. Another patient had self-resolving, mild, intermittent dysuria (median duration 5.0 days). Urinary tract infection was not reported. Urinary debris occurred in 6 men (75%), with a median duration of 12 days. Median overall International Index of Erectile Function-15 (IIEF-15) scores were similar at baseline and at 6 to 12 months (p=0.060), as were median IIEF-15 scores for intercourse satisfaction (p=0.433), sexual desire (p=0.622), and overall satisfaction (p=0.256). There was an improvement in lower urinary tract symptoms, assessed by International Prostate Symptom Score (IPSS), between baseline and 6 to 12 months (p=0.026). All 8 men with no baseline urinary incontinence were leak-free and pad-free by 9 months. No histological evidence of cancer was identified in 7 of 8 men biopsied at 6 months (87,5%); overall, the entire population (8 patients) was free of clinically significant cancer and had no evidence of disease on multi-parametric MRI at 6 to 12 months. MR guided Focused Ultrasound focal therapy of individual prostate cancer lesions, whether multifocal or unifocal, leads to a low rate of genitourinary side-effects and an encouraging rate of early absence of clinically significant prostate cancer.

40 CFR 80.581 - What are the batch testing and sample retention requirements for motor vehicle diesel fuel, NRLM...

Code of Federal Regulations, 2011 CFR

2011-07-01

... retention requirements for motor vehicle diesel fuel, NRLM diesel fuel, and ECA marine fuel? 80.581 Section...) REGULATION OF FUELS AND FUEL ADDITIVES Motor Vehicle Diesel Fuel; Nonroad, Locomotive, and Marine Diesel Fuel... requirements for motor vehicle diesel fuel, NRLM diesel fuel, and ECA marine fuel? (a) Beginning on June 1...

40 CFR 80.581 - What are the batch testing and sample retention requirements for motor vehicle diesel fuel, NRLM...

Code of Federal Regulations, 2010 CFR

2010-07-01

... retention requirements for motor vehicle diesel fuel, NRLM diesel fuel, and ECA marine fuel? 80.581 Section...) REGULATION OF FUELS AND FUEL ADDITIVES Motor Vehicle Diesel Fuel; Nonroad, Locomotive, and Marine Diesel Fuel... requirements for motor vehicle diesel fuel, NRLM diesel fuel, and ECA marine fuel? (a) Beginning on June 1...

Retroperitoneoscopic living donor nephrectomy: initial experience with a unique hand-assisted approach.

PubMed

Capolicchio, J-P; Feifer, A; Plante, M K; Tchervenkov, J

2011-01-01

The retroperitoneoscopic (RP) approach to live donor nephrectomy (LDN) may be advantageous for the donor because it avoids mobilization of peritoneal organs and provides direct access to the renal vessels. Notwithstanding, this approach is not popular, likely because of the steeper learning curve. We feel that hand-assistance (HA) can reduce the learning curve and in this study, we present our experience with a novel hand-assist approach to retroperitoneoscopic live donor nephrectomy (HARP-LDN). Over a one-yr period, 10 consecutive patients underwent left HARP-LDN with a mean body mass index of 29 and three with prior left abdomen surgery. The surgical technique utilizes a 7 cm, muscle-sparing incision for the hand-port with two endoscopic ports. Operative time was an average of 155 min., with no open conversions. Mean blood loss was 68 mL, and warm ischemia time was 2.5 min. Hospital stay averaged 2.7 d with postoperative complications limited to one urinary retention. Our modified HARP approach to left LDN is safe, effective and can be performed expeditiously. Our promising initial results require a larger patient cohort to confirm the advantages of the hand-assisted retroperitoneal technique. © 2010 John Wiley & Sons A/S.

7 CFR 3015.21 - Retention period.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Retention period. 3015.21 Section 3015.21 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Record Retention and Access Requirements § 3015.21...

20 CFR 655.1302 - Required pre-filing activity.

Code of Federal Regulations, 2010 CFR

2010-04-01

... as specified in this section. (c) Retention of documentation. An employer filing an Application for... the certification. There is no record retention requirement for any application (and supporting... steps. An employer filing an application must: (1) Submit a job order to the SWA serving the area of...

47 CFR 73.1212 - Sponsorship identification; list retention; related requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 4 2013-10-01 2013-10-01 false Sponsorship identification; list retention; related requirements. 73.1212 Section 73.1212 Telecommunication FEDERAL COMMUNICATIONS COMMISSION... location specified under § 73.3526. If the broadcast is originated by a network, the list may, instead, be...