Bladder Aspiration Research Articles

Urine collection techniques in non-toilet trained children: Switzerland's paediatric office practices in 2022.

Urine collection techniques in non-toilet trained children: Switzerland's paediatric office practices in 2022.

Microbiological profile and antibiotic resistance pattern of urinary tract isolates in febrile under-five children in North-Eastern Nigeria

Background: Urinary tract infections (UTIs) remain a common cause of childhood morbidity, if poorly treated or undiagnosed, could result in long-term morbidities e.g. hypertension, failure to thrive and end-stage renal disease (ESRD). An appropriate antimicrobial susceptibility pattern is essential.
 Objective: The study determined the profile and antibiotic sensitivity patterns of bacterial strains isolated from febrile under-five children in Azare, North-Eastern Nigeria.
 Methods: 145 febrile under-five children seen in Federal Medical Centre Azare over six months(March to August 2008)were enrolled in a hospital-based prospective study. Urine obtained by midstream and suprapubic bladder aspiration was subjected to urinalysis, urine microscopy, culture and sensitivity.
 Results: Of the 145 subjects enrolled, 34(23.4%) had UTI;24(70%) males and 10(30%) females .Gram-negative organisms accounted for 67.6%, Gram-positive organisms 32.4% of isolates; Escherichia coli in 12 (35.3%) cultures; Staphylococcus aureus; 11 (32.4%); Klebsiella species; 8 (23.5%).The gram- negative enteric bacilli had a high prevalence of resistance against ampicillin, amoxicillin, nalidixic acid, nitrofurantoin and co-trimoxazole.
 Conclusion: Escherichia coli was the most prevalent bacterial organisms isolated. Others were Klebsiella, Proteus and Pseudomonas species with Staphyloccocus aureus the only Gram-positive. The most effective agents were ceftriaxone, ciprofloxacin and gentamicin. A higher prevalence of UTIs was found in boys.

Comparison of percutaneous gallbladder aspiration with percutaneous cholecystostomy in acute cholecystostomy patients. Can gall bladder aspiration alone be sufficient?

The aim of this study is to compare the efficacy and complication rates of percutaneous gallbladder aspiration (PA) and percutaneous cholecystostomy (PC) in the management of AC and present the experiences of a single third-line center. The results of 159 patients with AC who admitted to our hospital between 2015 and 2020, that underwent PA and PC procedures, because they did not respond to conservative treatment and LC could not be performed, were retrospectively analyzed. Clinical and laboratory data before and 3 days after PC and PA procedure, technical success, complications, response to treatment, duration of hospital stay, and reverse transcriptase-polymerase chain reaction (RT-PCR) test results were recorded. Out of 159 patients, 22 (8 men 14 women) underwent PA procedure and 137 (57 men 80 women) underwent PC. No significant difference was detected between the PA and PC groups in terms of clinical recovery (P: 0.532) and duration of hospital stay (P: 0.138) in 72 h. The technical success of both procedures was 100%. While 20 out of 22 patients with PA were having a noticable recovery, only one was treated with twice PA procedures and a complete recovery was observed (4.5%). Complication rates were low in both groups and were statistically insignificant (P: 1.00). In this pandemic period, PA and PC procedures are effective, reliable, and successful treatment method that can be applied at the bedside for critical patients with AC who are not compatible with surgery, which are safe for health workers and low-risk minimal invasive procedures for patients. In uncomplicated AC patients, PA should be performed, and if there is no response to treatment, PC should be reserved as a salvage procedure. The PC procedure should be performed in patients with AC who have developed complications and are not suitable for surgery.

Clean-catching urine from pigs: A method for collecting quality specimens for urinalysis and microbiological culturing in a laboratory environment.

Urine is an important biological specimen for assessing various metabolic functions and drug clearance. In urinary tract infection research, urine is particularly important as urinary bacterial titres constitute the main diagnostic outcome for assessing the course of infection. Collecting uncontaminated urine samples from pigs can be done by bladder catheterization or suprapubic bladder aspiration, which are both laborious and invasive procedures that require the need for anaesthesia. To improve animal welfare and optimize urine sampling protocols, we developed a method of clean-catching midstream urine specimens from pigs during spontaneous micturition. The quality of urine specimens collected by clean-catch, bladder catheter and suprapubic bladder aspiration were compared using microbiological culturing. We show that urine specimens collected by clean-catch are only minimally contaminated by skin- and vaginal-commensals with no influence on urinary bacterial titres during ongoing infection. In conclusion, we describe a method in which spontaneous micturition can be prompted in pigs, facilitating fast and reliable collection of quality specimens suitable for microbiological culturing. The method supersedes the need for anaesthesia, which not only represents a considerable refinement in terms of animal welfare but also facilitates more frequent collection of specimens that can enhance the scientific outcome of experimental animal studies in pigs.

Trends in Procedures in the Neonatal Intensive Care Unit.

The aim of the study is to identify the rates and trends of various procedures performed on newborns. The Healthcare Cost and Utilization Project (HCUP) database for the years 2002 to 2015 was queried for the number of livebirths, and various procedures using International Classification of Diseases, Ninth Revision (ICD-9) codes. These were adjusted to the rate of livebirths in each particular year. A hypothetical high-volume hospital based on data from the last 5 years was used to estimate the frequency of each procedure. Over the study period, there was a decline in the rates of exchange transfusions and placement of arterial catheters. There was an increase in the rates of thoracentesis, abdominal paracentesis, placement of umbilical venous catheter (UVC) lines, and central lines with ultrasound or fluoroscopic guidance. No change was observed in the rates of unguided central lines, pericardiocentesis, bladder aspiration, intubations, and LP. Intubations were the most performed procedures. Placement of UVC, central venous lines (including PICCs), arterial catheters, and LP were relatively common, whereas others were rare such as pericardiocentesis and paracentesis. Some potentially lifesaving procedures are extremely rare or decreasing in incidence. There has also been an increase in utilization of fluoroscopic/ultrasound guidance for the placement of central venous catheters. · Advances in neonatal care have impacted the number of procedures performed in the NICU.. · It is unclear whether invasive procedures occur at rates sufficient for adequate training and maintenance of skills.. · Understanding the NICU procedural trends is important in designing simulation and competency-based medical education programs..

Suprapubic bladder aspiration: A novel method in the diagnosis of retrograde ejaculation

Introduction and objectivesTo investigate the role of suprapubic bladder aspiration (SBA) in the diagnosis of retrograde ejaculation (RE) which is diagnosed with the observation of sperm in post-ejaculatory urine (PEU). However, sperm is also observed in PEU after the wash out of the retained ejaculate in the urethra with the expulsion of urine in several subjects. Therefore, detection of sperm in PEU in the diagnosis of RE is problematic and a better method is needed to overcome the ambiguity of positive PEU and to identify which patient experience true RE. Material and methodsA cohort of patients underwent an examination for RE over a two-year period at a single specialist centre. All patients underwent SBA and semen analysis. Sperm was investigated in urine aspirated from the bladder and in PEU. ResultsThirty-two patients (age range 18–62 years) underwent SBA and PEU for investigation of RE. Sperm was detected both in SBA and PEU in 19 patients, while 5 patients revealed sperm only in PEU. The mean number of sperm found in SBA was less than the mean number of sperm observed in PEU in all 19 patients. ConclusionSBA is a reliable and feasible method in the diagnosis of RE and can distinguish the true RE in which sperm flows backward into the bladder from the retained ejaculate in the urethra. The whole ejaculate does not likely flow retrogradely and RE could be a partial leakage of the ejaculate into the bladder.

S2319 A Rare Case of Primary Gallbladder MALTOMA Masquerading as Cholecystitis

INTRODUCTION: Mucosa-associated lymphoid tissue (MALTOMA), a marginal zone lymphoma, is a low-grade B cell non-Hodgkin’s lymphoma. It is the third most common non-Hodgkin’s lymphoma and commonly involves the stomach, lung, thyroid, and salivary glands. It’s occurrence in the gallbladder as a primary site is very rare. We present a unique case of a symptomatic patient who was diagnosed to have a possible cholecystitis with wall thickening on CT scan that was proven to be MALTOMA following endoscopicultrasound (EUS)-guided biopsy. CASE DESCRIPTION/METHODS: 78-year-old female with a PMH of hypothyroidism and GERD, presented with abdominal pain of 2 weeksduration. The patient underwent CT scan, which showed cholecystitis with gallbladder wall thickening (Figure 1), and elevated liver enzymes. EUS was performed for evaluation of elevated LFTs and showed diffuse gallbladder wall thickening measuring 8 mm (Figure 2). EUS-guided biopsy of the gall bladder wall showed low grade marginal zone B-cell lymphoma. Patient subsequently underwent cholecystectomy withsurgical pathology confirming the diagnosis of MALTOMA (Figure 3), with negative margins; and a negative post-operative PET scan on surveillance. DISCUSSION: Malignant lymphoma constitutes about 0.1–0.2% of gall bladder malignancies and about 40% ofmalignant lymphomas. The possible mechanism of MALTOMA in the gall bladder was thought to be due to lymphocytic infiltration secondary to chronic inflammation from infection or cholelithiasis and thesynthesis of fusion protein AP12 MALT1 from antigenic stimulation. As reported in our case, MALTOMA is commonly reported in females and often presents with abdominal pain, nausea, and vomiting. The radiological findings of MALTOMA have varied between cases in the literature, either as wall thickening ,a mass, a polypoid lesion, or a submucosal tumor. In the present case, focal wall thickening andinflammation was seen, which is more suggestive of cholecystitis. Given such scenarios, it is importantto keep MALTOMA on the differential. Surgery is the most common treatment in localized gall bladder lymphoma and carries an excellent prognosis. The recurrence rate after treatment for MALTOMA was reported as 37%, so it very important to perform frequent surveillance.Figure 1.: CT scan showed cholecystitis with gall bladder wall thickening (shown by arrow).Figure 2.: 2A: Gall bladder wall thickening measuring 8 mm (shown by arrow), 2B: Fine needle aspiration of the gall bladder (shown by arrow).Figure 3.: Lymphocytic proliferation in the gall bladder mucosa.

Estimation of successful capping with complete aspiration of bladder via nephroureterostomy tube.

BACKGROUNDUreteral stent and nephroureterostomy tube (NUT) are treatments of ureteral obstruction. Ureteral stent provides better quality of life. Internalization of NUT is desired whenever possible.AIMTo assess outcomes of capping trial among cancer patients with complete aspiration of retained contrast from bladder via NUT.METHODSOur Institutional Review Board approved retrospective review of all NUT placement, NUT exchange and conversion of nephrostomy catheter into NUT performed during June 2013 to June 2015 (n = 578). Cases were excluded due to lack of imaging of bladder (n = 37), incomplete aspiration of bladder (n = 324), no attempt at capping NUT (n = 166), and patients with confounding factors interfering with results of capping trial including non-compliant bladder, bladder outlet obstruction and catheter malposition (n = 14). Study group consisted of 37 procedures in 34 patients (male 19, female 15, age 2-83 years, average 58, median 61) most with cancer (prostate 8, endometrial 5, bladder 4, colorectal 4, breast 2, gastric 2, neuroblastoma 2, cervical 1, ovarian 1, renal 1, sarcoma 1, urothelial 1 and testicular 1) and one with Crohn’s disease. Medical records were reviewed to assess outcomes of capping trial. Exact 95% confidence intervals (95%CI) were calculated.RESULTSAmong patients with complete aspiration of retained contrast, 30 (81%, 95%CI: 0.65-0.92) catheters were successfully capped (range 12-94 d, average 40, median 24.5) until planned conversion to internal stent (23), routine exchange (5), removal (1) or death unrelated to catheter (1). Seven capping trials (19%, 95%CI: 0.08-0.35) were unsuccessful (range 2-22 d, average 12, median 10) due to leakage (3), elevated creatinine (2), fever/hematuria (1) and nausea/vomiting (1).CONCLUSIONCapping trial success among patients with complete aspiration of retained contrast/ urine from bladder via NUT appears high.

Comparison of the role of ultrasound guided transhepatic aspiration of gallbladder versus conservative management of acute calculous cholecystitis

Background: Gall stone disease remains one of the most common medical problem leading to surgical intervention. Cholecystitis accounts for 3-10% of abdominal pain worldwide. Acute cholecystitis is the most common complication of cholelithiasis accounting for 14 to 30% of cholecystectomies performed in many countries. Symptoms in cholecystitis are due to impaction of stone and subsequent distention of gallbladder with inflammation. Study is aimed to clarify the role of ultrasound guided transhepatic gallbladder aspiration in the early management of acute calculous cholecystitis.Methods: The study was conducted in total of 40 patients presenting with acute cholecystitis. 20 patients underwent ultrasound guided transhepatic aspiration of gallbladder with antibiotics (group A) and 20 patients were given antibiotics only (group B). Data were collected before intervention and post intervention duration of stay, pain according to visual analog scale, leucocytosis and fever were recorded for analysis. No complications were related to aspiration procedure.Results: Both groups were comparable. Group A patients had better pain relief (p=0.0001 day on 2 and p=0.004 on day 3 post aspiration), percentage reduction of leucocyte count (p=0.041 on day 3) and duration of hospital stay (p=0.004) which were statistically significant.Conclusions: Ultrasound guided transhepatic aspiration of gall bladder with antibiotics in acute cholecystitis results in better pain profile, faster reduction in leucocyte count and shorter duration of hospital stay when compared to antibiotics alone.

Microbiology of urine samples obtained through suprapubic bladder aspiration: A 10-year epidemiological snapshot

Purpose Suprapubic bladder aspiration is an invasive procedure in which a needle is used to obtain a urine sample directly from the bladder. Its advantages are sensitivity (detection of significant bacteriuria is close to 100%), suitability for cultivation of anaerobic bacteria, and low risk of contamination. Our purpose was to characterize the microbiology and epidemiology of urine samples obtained through this procedure in the Clinical Center of the University of Szeged’s Institute of Clinical Microbiology between 2008 and 2017. Materials and methods Over the 10-year period, patient data were collected and suprapubic bladder aspirations were performed, and the samples are processed in accordance with routine laboratory procedures in clinical bacteriology. Results Of 187 urine samples obtained from 148 patients, 32.6% (n = 61) were culture-positive (defined as 102 colony forming units/ml or more). Conclusions This method should be considered an important sampling procedure in the differential diagnostics of upper urinary tract infections, particularly in children <2 years of age, and in older people, hospitalized patients.

Prevalence of Asymptomatic Bacteriuria in Children: A Meta-Analysis

To determine the point prevalence of bacteriuria and bacteriuria without pyuria in asymptomatic children by a systematic review of the literature. We searched MEDLINE and EMBASE for English-, French-, German-, Italian-, and Spanish-language articles. We included articles reporting data on bacteriuria in asymptomatic children up to 19years of age who had urine collected by suprapubic bladder aspiration, bladder catheterization, or by 3 consecutive clean catch samples. Two independent reviewers assessed studies for inclusion and abstracted data. Fourteen studies (49 806 children) were included. The prevalence of asymptomatic bacteriuria was 0.37% (95% CI, 0.09-0.82) in boys and 0.47% (95% CI, 0.36-0.59) in girls. The corresponding values for asymptomatic bacteriuria without pyuria were 0.18% (95% CI, 0.02-0.51) and 0.38% (95% CI, 0.22-0.58), respectively. The subgroups with the highest prevalence of asymptomatic bacteriuria were uncircumcised males <1year of age andfemales>2years of age. In males, the prevalence of asymptomatic bacteriuria after infancy was 0.08% (95% CI, 0.01-0.37). The median duration of asymptomatic bacteriuria in untreated boys and girls, from the one study reporting this outcome, was 1.5 and 2months, respectively. Some clinicians are concerned that when a preverbal child with asymptomatic bacteriuria develops a nonlocalizing febrile illness and presents for evaluation, they may be mistakenly diagnosed as having a urinary tract infection (UTI). Given that the prevalence of asymptomatic bacteriuria is considerably lower than the prevalence of UTI in most subgroups examined, this will occur extremely rarely. These data suggest that the current definition of UTI should be revisited.

Ultrasound Guided Percutaneous Transhepatic Gall bladder Aspiration (PTGBA) in the Treatment of Mushroom Poisoning

Mushroom poisonings (Mycetismus) are rare conditions have been reported frequently from North East India during the monsoon seasons. In one of the earlier studies we noted a high mortality (43.75%) even after using all the conventional agents in literature. Studies in dogs have shown that the toxins are excreted in the bile and much of the toxin excreted in this way is reabsorbed into the liver with the bile. Interruption of the cycling of the toxin by bile duct cannulation can reduce the toxic effects of α-amantin in dogs. We report three males, (58, 28 and 24 years old respectively) who came to our institute with mushroom poisoning presenting with dehydration, acute liver failure, raised liver enzymes and hyperbilirubinemia. Though they were given conventional treatment their raised liver enzymes indicated high risk for mortality. After proper consent, ultrasound guided percutaneous transhepatic gall bladder aspiration (UPTGA) was performed in all three of them under strict aspeptic and antiseptic conditions. Bile was aspirated and preserved for toxicological analysis. The patients improved both symptomatically and biochemically after the procedure. No complications were noted in these patients and they were discharged after a few days of observation in our hospital. We conclude that ultrasound guided percutaneous transhepatic Gall bladder Aspiration (PTGBA) is a simple bedside procedure that can be safely done in high risk patients of amanita mushroom poisoning.

Urinary tract infections in children

Urinary tract infections (UTI) are the most common bacterial infections in children. The symptoms are not very specific and range from abdominal pain, poor feeding to nocturnal urinary incontinence. The technique of collecting urine plays an important role for securing the diagnosis. The best way to obtain urine in non-toilet-trained children is catheterization or suprapubic bladder aspiration. In toilet-trained children midstream urine is an acceptable alternative after cleaning the foreskin or labia. In the case of an infection aprompt empirical antibiotic therapy is necessary to reduce the risk of parenchymal scarring of the kidneys. There are different approaches to diagnose vesicoureteral reflux in different countries. The commonly used standard approach in Germany is voiding cystourethrography. In the case of reflux dimercaptosuccinic acid (DMSA) scintigraphy should beperformed additionally to exclude renal scarring (bottom-up approach).

Percutaneous aspiration of the gall bladder for the treatment of acute cholecystitis: a prospective study.

Urgent laparoscopic cholecystectomy has been established as the best treatment for acute cholecystitis. However, conservative treatment is advocated for high-risk patients. Failure of conservative treatment can result in high-risk operations with relatively high rates of operative morbidity. Percutaneous cholecystostomy is a good option for these patients. Recently, percutaneous aspiration of the gall bladder without drain has been described. A protocol of initial conservative management in high-operative-risk patients admitted with acute cholecystitis was prospectively assessed. Patients who did not respond to antibiotics were treated with percutaneous trans-hepatic aspiration of the gall bladder under ultrasound guidance. Following discharge, the patients were seen in the outpatient clinic and elective laparoscopic cholecystectomy was considered and scheduled as necessary. Between January 2011 and December 2012, 33 patients with persistent clinical and sonographic signs of acute cholecystitis after failure of initial antibiotic treatment underwent gall bladder aspiration under ultrasound guidance. No complications related to the procedure were reported. In 25 patients (76%), the procedure was successful and they were discharged. Seven patients needed repeated aspiration. Eight patients (24%) who did not improve underwent percutaneous cholecystostomy and were discharged with a drain and later reevaluated for elective surgery. The mean hospital stay of patients with successful aspiration was 3days. During the follow-up period, 23 patients underwent elective interval laparoscopic cholecystectomy. Two were converted to open surgery (8.7%). Conservative treatment and delayed operation is an acceptable option for acute cholecystitis. Percutaneous gall bladder aspiration is a simple and effective procedure, with a high success rate and low morbidity. Laparoscopic cholecystectomy after drainage of the gall bladder has low morbidity with a relatively low conversion rate.

Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age

Administration of oral sucrose or glucose with and without non-nutritive sucking is frequently used as a non-pharmacological intervention for needle-related procedural pain relief in infants. To determine the effectiveness of sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age compared with no treatment, placebo, other sweet-tasting solutions, or pharmacological or other non-pharmacological pain-relieving methods. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012); MEDLINE via Ovid (1966 to 2012); CINAHL via OVID (1982 to 2012). The World Health Organization International Clinical Trials Registry Platform was also searched for any ongoing trials. Clinical trial registries, conference proceedings and references for randomised controlled trials (RCTs) were also searched. An updated search was run to capture any new publications before finalising the review in April 2012 and no new included studies were identified. Two review authors (MK & JF) independently abstracted data and assessed quality using a standard form. Authors have been contacted for missing data. Randomised-controlled trials using a sweet-tasting solution to treat pain in healthy term infants (gestational age 37 weeks and over), between one month and 12 months of age who required needle-related procedures. These procedures included but were not limited to: subcutaneous or intramuscular injections, venepuncture, and heel lance. Studies in which the painful procedure was circumcision, lumbar puncture or supra-pubic bladder aspiration were not included as they are more severe and painful than needle-related procedures. Control conditions included no treatment or placebo (water) or any other identical intervention (same appearance and consistency) without active ingredient, another sweet-tasting solution, a pharmacological pain-relieving method (e.g. paracetamol, topical anaesthetic cream), non-pharmacological pain-relieving method (e.g. distraction method, non-nutritive sucking). Assessment of trial quality, data extraction and synthesis of data were performed using standard methods of the Cochrane Pain, Palliative and Supportive Care Group. We report mean differences (MD) with 95% confidence intervals (CI) using fixed-effect models as appropriate for continuous outcome measures. We planned to report risk ratio (RR) and risk difference (RD) for dichotomous outcomes. The Chi(2) test and I(2) statistic were used to assess between-study heterogeneity. Sixty-five (65) studies were identified for possible inclusion in this review. Fourteen published RCTs with a total of 1551 participants met the inclusion criteria. Duration of cry was significantly reduced in infants who were administered a sweet-tasting solution [MD -13.47 (95% CI -16.80 to -10.15)], P < 0.00001 compared with water. However, there was considerable heterogeneity between the studies (I(2) = 94%) that we were unable to explain. Meta-analysis was not able to be undertaken for any of the other outcome measures, except for cry duration, because of differences in study design. However, most of the individual studies that measured pain found sucrose to significantly reduce pain compared with the control group. One study compared sucrose and Lidocaine-prilocaine cream and no significant difference was found between the two treatments for the outcomes pain and cry duration. Due to the differences between the studies, we were unable to identify the optimal concentration, volume or method of administration of sweet-tasting solutions in infants aged one to 12 months. Further large RCTs are needed. There is insufficient evidence to confidently judge the effectiveness of sweet-tasting solutions in reducing needle-related pain in infants (one month to 12 months of age). The treatments do, however, appear promising. Data from a series of individual trials are promising, as are the results from a subset meta-analysis of studies measuring duration of crying. Further well controlled RCTs are warranted in this population to determine the optimal concentration, volume, method of administration, and possible adverse effects.

La punción suprapúbica guiada por ecografía aumenta el rendimiento de la técnica en menores de 4 meses

IntroductionSuprapubic bladder aspiration (SBA) is a widely accepted technique used to collect uncontaminated urine samples from infants with suspected urinary tract infection (UTI). Ultrasound-based guidance improves the success rates. The standard measurements for a successful procedure, however, have been scarcely evaluated. ObjectiveTo assess the efficacy of ultrasound-guided SBA versus blind SBA, and to establish the bladder measurements associated with optimal results. Patients and methodUltrasound-guided SBA was performed in 50 infants≤4 months of age with suspected UTI, and the anteroposterior (APD) and transverse diameter of the bladder were determined using ultrasound equipment (Esaote MyLab® 25 Gold, and Hewlett Packard Sonos® 5500) with a 3.5MHz convex probe. The success rates and the total volumes of collected urine were compared to a control group of 50 patients of similar age and clinical characteristics, to whom conventional blind SBA was performed. ResultsThe rate of successful ultrasound-guided SBA was 92.3% compared to 30.8% in the blind SBA group (P<.05). The collected urine volumes were 7.65±1.85ml and 6.1±2.13ml, respectively (P<.001). An APD≥2cm was associated with an optimal performance of the technique (97.8% success). No major complications were observed in either group. ConclusionsUltrasound-guided SBA is significantly more successful than blind SBA in infants less than 4 months of age, with an APD≥2cm being optimal for conducting the procedure.

1041 UROLOGICAL INSTRUMENTS IN THE 10TH CENTURY- CONTRIBUTIONS OF ALBUCASIS, THE SHEIKH OF SURGERY

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 20121041 UROLOGICAL INSTRUMENTS IN THE 10TH CENTURY- CONTRIBUTIONS OF ALBUCASIS, THE SHEIKH OF SURGERY Fahd Khan, Sanjeev Madaan, Ian Dickinson, and Seshadri Sriprasad Fahd KhanFahd Khan Dartford, United Kingdom More articles by this author , Sanjeev MadaanSanjeev Madaan Dartford, United Kingdom More articles by this author , Ian DickinsonIan Dickinson Dartford, United Kingdom More articles by this author , and Seshadri SriprasadSeshadri Sriprasad Dartford, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1146AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi, also known as Albucasis, lived in Andalusia, Spain from 936-1013 AD. Albucasis, the “Greatest Physician of his Age” was a court surgeon and prominent chemist for the Muslim ruler of Al Andulus. We are able to observe his findings from a manuscript he wrote called the Al Tasrif which contains guidelines for surgery that are still referred to today. METHODS Images of the results of the experiments will be reproduced with permission. A historical account using the Al Tasrif and other electronic resources. RESULTS Albucasis is renowned for his contribution to surgery and urology. Through his magnum opus called the Al Tasrif he provided a comprehensive set of guidelines on the practices of surgery, urology, medicine, otolaryngology, obstetrics, and orthopedics. The book has been implemented for over 700 years; it was translated by the Italian, Gerard di Cremona. Furthermore, Albucasis describes the treatments of over 300 diseases, by the utilization of herbs and ointments, and the structures and use of over 200 surgical instruments, many pertinent to practices today. For urinary retention, Albucasis describes a straight catheter made from silver and lubricated with egg white which was different to Galen's S-shaped catheter. For bladder irrigation unlike his predecessors, Celsus and Paulus, Albucasis described in great detail and with many illustrations, the Zaraqqa syringe, comprised of an elongated, silver tube containing three holes in it, used for both irrigation and bladder aspiration. Albucasis observed previous works, and concluded that the best method of circumcision was the use of scissors and thread ligature. With respect to renal tract calculi, he established early lithotomy. Straight forceps known as Al Kalaleeb were implemented to break down bladder calculi via an incision through the perineum. Al Mishaab drills were gently applied to break down urethral calculi. CONCLUSIONS Albucasis contributed an abundance to many fields of surgery. His theories of medical science were thought to be more sophisticated than that of who preceded him whether it be Galen, Ammonius, or Susruta. His teachings still echo over 1000 years in the application of urological surgery. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e422-e423 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fahd Khan Dartford, United Kingdom More articles by this author Sanjeev Madaan Dartford, United Kingdom More articles by this author Ian Dickinson Dartford, United Kingdom More articles by this author Seshadri Sriprasad Dartford, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection: A large prospective study with long-term follow up using Plastibell

ObjectiveTo evaluate the preventive effect of neonatal circumcision on urinary tract infection and the incidence of complications following neonatal circumcision using Plastibell. Materials and methodsA prospective study was carried out between 2004 and 2008. During this period, there were 3000 neonatal circumcisions. All of the cases were examined for any complications 1 week later, and occurrence of meatal stenosis was followed up to 15 months of age. In this group, urine analysis and culture was successfully performed four times for 2000 circumcised infants at 1.5, 3, 9 and 15 months. In the control group of 3000 uncircumcised infants, 1000 cases accomplished urine analysis and culture at the same designated intervals. ResultsA positive urine culture was observed in none of the circumcised cases and in 20 (2%) uncircumcised cases after obtaining a suprapubic bladder aspiration sample. The latter 20 infants were circumcised and follow-up cultures were negative in 17 cases. The overall complication rate in the circumcised group was 1.6%. The difference in frequency of urinary tract infection between the two groups was statistically significant (P<0.0001). ConclusionNeonatal circumcision has few complications and reduces the incidence of asymptomatic urinary infection. It may be considered as a preventative health measure.

Temporal variations of the postnatal rat urinary proteome as a reflection of systemic maturation

The rat kidney matures during the first 2 wk of life, suggesting that temporal variations in the urinary proteome may occur during this period. We describe the urine proteome during postnatal development in the rat and demonstrate specific proteomic changes corresponding to developmental milestones. Urine was collected from 30 rats at five postnatal (P) days of life (P1, P3, P7, P14, and >P30) by bladder aspiration. The proteome was assessed by nano-ESI-LC-MS/MS. For identification, we used stringent criteria to provide a 1% false positive rate at the peptide level. The proteins in common at each time interval decreased during postnatal maturation. When comparing all five developmental times, six proteins were ubiquitously present. We detected 14 proteins involved with cellular adhesion, structure, or proliferation and differentiation only during neonatal development. Additionally, 30 proteins were specific to adults, of which 13 originated from the prostate or seminal vesicle. This is the first MS characterization of the normal urinary proteome in early postnatal rodent development that demonstrates distinct differences correlating with different stages of tissue maturation. Further characterization of the normal urinary proteome may provide the basis for identification of urinary biomarkers of diseases of the urinary tract.

Métodos para la recogida de muestras de orina para urocultivo y perfil urinario

A review of the scientific evidence available on the validity of existing sample collection methods for urine culture and analysis in childhood is presented. Few studies evaluating diagnostic tests have analyzed the various available techniques with respect to valid patterns of reference. Except for clean catch midstream urine samples, there are no estimators of validity (sensitivity, specificity, probability quotients) that can be generalized to most of the techniques and that could guide decision making. Consequently, data from descriptive studies on the risk of contamination, feasibility, safety and acceptability of each technique will have to be considered in decision making. Urine collection by means of adhesive perineal bag is the most widely used method in Spain in children who do not control urine emission. Nevertheless, this technique has a high risk of contamination and a very low positive predictive value, limiting its diagnostic utility. Urethral catheterization and suprapubic bladder aspiration are considered the tests of choice; however, because these tests are invasive, their use is restricted. Therefore, when choosing the technique to be used, the patient's circumstances and our working environment will have to be considered.