Common Urinary Disorders Research Articles

Proteomics of urinary small extracellular vesicles in early diagnosis of kidney diseases in children-expectations and limitations.

The primary function of the kidneys is to maintain systemic homeostasis (disruption of renal structure and function results in multilevel impairment of body function). Kidney diseases are characterized by a chronic, progressive course and may result in the development of chronic kidney disease (CKD). Evaluation of the composition of the proteome of urinary small extracellular vesicles (sEVs) as a so-called liquid biopsy is a promising new research direction. Knowing the composition of sEV could allow localization of cellular changes in specific sections of the nephron or the interstitial tissue before fixed changes, detectable only at an advanced stage of the disease, occur. Research is currently underway on the role of sEVs in the diagnosis and monitoring of many disease entities. Reports in the literature on the subject include: diabetic nephropathy, focal glomerulosclerosis in the course of glomerulopathies, renal fibrosis of various etiologies. Studies on pediatric patients are still few, involving piloting if small groups of patients without validation studies. Here, we review the literature addressing the use of sEV for diagnosis of the most common urinary disorders in children. We evaluate the clinical utility and define limitations of markers present in sEV as potential liquid biopsy.

PSIX-9 Activation of Multiple Inflammatory Signaling Pathways May Contribute to the Pathogenesis of Idiopathic Cystitis in Felines

Abstract Feline idiopathic cystitis (FIC) is a common urinary disorder in domestic cats. Clinical signs include straining or failing to urinate, frequent urination, and discolored urine. Inflammation is a key characteristic in the pathogenesis of cystitis. We assessed circulating inflammatory markers in a retrospective study in cats housed in the Hill’s colony diagnosed with cystitis (n = 4; 15.2 to 18.6yr) and in control cats (n = 8; 5.9 to 16.5 yr). Blood samples were collected at end-of-life immediately before necropsy after they had lived their full lives. End-of-life pathology reports indicated inflammation and presence of inflammatory infiltrates in the bladder with some cats also showing renal inflammation. RNA was extracted from blood collected in PAXgene tubes, and gene expression investigated using NanoString nCounter platform. Analysis was performed using the nSolver software. There was a significant increase in IRAK4, a kinase that activates the NFκB pro-inflammatory signaling pathway, in FIC when compared with controls (1.56, P < 0.05). Small molecule inhibitors of IRAK4 are being developed as targets of inflammation. Signaling molecules in the NFκB pathway were also significantly increased including Rel A (p65 subunit; 1.3 fold), NFκB1 (p100 subunit; 1.3 fold), IKBKB (1.29 fold), and TANK (1.46 fold) in FIC cats (all P < 0.05). Another signaling pathway contributing to pro-inflammatory signaling is the JAK/STAT pathway. There was a significant increase in JAK2 (1.65) and STAT3 (1.48). Blockade of JAK2/STAT3 pathway can attenuate cytokine synthesis and reduce inflammation. STAT6 was also significantly increased in FIC cats (1.35). Activation of STAT6, by IL-4 and IL-13, can lead to systemic inflammation. Activation of the complement immune pathway was also seen in FIC. While the complement system is important for an innate immune response, its sustained activation leads to chronic pathological inflammation. There was a significant increase in complement C1s, an initiator of classical complement activation pathway, in FIC cats (1.43; P < 0.05). A late component, complement C7, was also upregulated in FIC (2.01 fold; P < 0.05). C7 binds to the C5b-6 complex which eventually becomes part of the terminal complement complex. Increased abundance of C7 and eventual terminal complement complex are associated with increased inflammation and may be important in the progression of FIC. There was also an increase in PECAM1 in FIC cats (1.87; P < 0.05). Signaling through PECAM1 leads to the activation of neutrophils and monocytes. DUSP1 was also elevated in FIC (2.24; P < 0.05). Increased abundance of DUSP1 is hypothesized to be a predictor of chronic subclinical inflammation in humans with cardiovascular disease. Our results identify activation of pro-inflammatory signaling pathways that may be potential targets for alleviating inflammation in cystitis. Pathogenesis of FIC is likely multi-factorial, and nutritional intervention to attenuate the activation of inflammatory pathways may be an important strategy in the management of cystitis.

A deep learning model for automated kidney calculi detection on non-contrast computed tomography scans in dogs.

Nephrolithiasis is one of the most common urinary disorders in dogs. Although a majority of kidney calculi are non-obstructive and are likely to be asymptomatic, they can lead to parenchymal loss and obstruction as they progress. Thus, early diagnosis of kidney calculi is important for patient monitoring and better prognosis. However, detecting kidney calculi and monitoring changes in the sizes of the calculi from computed tomography (CT) images is time-consuming for clinicians. This study, in a first of its kind, aims to develop a deep learning model for automatic kidney calculi detection using pre-contrast CT images of dogs. A total of 34,655 transverseimage slices obtained from 76 dogs with kidney calculi were used to develop the deep learning model. Because of the differences in kidney location and calculi sizes in dogs compared to humans, several processing methods were used. The first stage of the models, based on the Attention U-Net (AttUNet), was designed to detect the kidney for the coarse feature map. Five different models-AttUNet, UTNet, TransUNet, SwinUNet, and RBCANet-were used in the second stage to detect the calculi in the kidneys, and the performance of the models was evaluated. Compared with a previously developed model, all the models developed in this study yielded better dice similarity coefficients (DSCs) for the automatic segmentation of the kidney. To detect kidney calculi, RBCANet and SwinUNet yielded the best DSC, which was 0.74. In conclusion, the deep learning model developed in this study can be useful for the automated detection of kidney calculi.

Urinary brain-derived neurotrophic factor and nerve growth factor as noninvasive biomarkers of overactive bladder in children.

IntroductionOveractive bladder (OAB) is the most common urinary disorder and the leading cause of functional daytime intermittent urinary incontinence in children. The aim of this study was to determine whether urinary brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) concentrations, normalized to urine creatinine, could be used as biomarkers for diagnosis and treatment monitoring of OAB in children.Materials and methodsUrine samples of 48 pediatric patients with OAB were collected at the start of anticholinergic therapy (baseline), at follow-up visits (3 and 6 months), and from 48 healthy controls. Urinary BDNF and NGF concentrations were determined by ELISA method (Merck, Darmstadt, Germany) and Luminex method (Thermo Fisher Scientific, Waltham, USA). Differences of frequency between quantifiable analyte concentrations between subject groups were determined using Fisher’s exact test.ResultsThere was no statistically significant difference between quantifiable analyte concentrations between patients at baseline and the control group for BDNF and NGF by either the ELISA or Luminex method (P = 1.000, P = 0.170, P = 1.000, and P = N/A, respectively). There was a statistically significant difference between quantifiable BDNF by the ELISA method between patients at baseline and complete success follow-up (P = 0.027), while BDNF by Luminex method and NGF by both methods were not statistically significant (P = 0.078, P = 0.519, and P = N/A, respectively).ConclusionsThis study did not demonstrate that urinary BDNF and NGF concentrations, can be used as biomarkers for diagnosis and therapy monitoring of OAB in children.

A Clinical Study to Evaluate Efficacy of Cap Ashma: 6 Hypothetical and Varunadi Kashya in the Management of Mootra Ashmari w.s.r.to Urolithiasis: A Research Article

Abstract: Mutrasmari is one of the most common urinary disorders . Acharya Susruta , the pioneer in the art and science of surgery has described widely and comprehensively About Mutrasmari along with its classification , symptomatology , etiology , pathology , complications and its management.³ Formation of urinary calculi is described in Ayurvedika scriptures Mutrasmari . The diagnostic part in case of calculi by ancient Acharya seems to be true even at present . Formation ofMutrasmari , according to Susruta , is due to SrotoVaigunya resulting from DusitaKapha localized in Basti , in conjunction with PradusitaVata and Pitta . Mootraashmari or urinary stone is a most painful & common disease in our country & pain due to kidney stone is known as worse condition than that of labour pain It is the third most common disease of the urinary tract . Mootraashmari is very high incidence occurring due to the high mineral content of water and hot climate. Key points: Asmari, Ashma -6 , Varunadi kashya,

Increased Gene Expression of Circulating Pro‐inflammatory Cytokines in Felines with Idiopathic Cystitis

Feline idiopathic cystitis (FIC) is one of the common urinary disorders of domestic cats. Inflammation is a key characteristic in the pathogenesis of cystitis and pro-inflammatory cytokines and chemokines have been hypothesized to contribute to the progression of cystitis. Several cytokines have been reported in the urine and bladder in animal models of cystitis and in humans. Circulating levels of cytokines and chemokines are important biomarkers to assess the presence and severity of FIC and may also be useful as a response variable to assess dietary intervention. We assessed the circulating inflammatory markers in a retrospective study in cats with cystitis (n=6; 9.2-18.6 yr) from blood samples collected at necropsy, as well as in control cats (n=6; 5.9-14.6 yr). While most cats had been diagnosed with idiopathic cystitis during their life-time, two cats also were diagnosed with urinary tract infection. End-of-life pathology reports indicated inflammation and presence of inflammatory infiltrates in the bladder (lamina propria) with some cats also showing renal inflammation. RNA was extracted from blood samples, and we assessed the circulating levels of inflammatory genes using ThermoFisher Scientific Custom TaqMan array plates that were feline-specific, in the blood of cats obtained at the end-of-life. Data were analyzed using the using the ΔΔCt method using HPRT as the housekeeping gene. The levels of circulating mRNA that were increased greater than 1.5-fold in the FIC cats, when compared to controls, included interleukin-4 (>1.96-fold), interleukin-1b (>1.75), bone morphogenetic protein -2 (>1.74), interleukin-8 (CXCL8; >1.73), interleukin-16 (>1.7), and CSF-1 (>1.58). While IL-4 may have some anti-inflammatory effects, an increase in IL-4 can also lead to T-cell proliferation and increased inflammation. An increase in IL-16, a chemoattractant and activator of T-cells, as well as IL-8, indicates an important role of T-cell activation in the pathogenesis and progression of cystitis. Our results identify elevated levels of several pro-inflammatory molecules that may be potential targets for alleviating chronic inflammation associated with cystitis. Nutritional intervention to reduce the levels of selected inflammatory cytokines may be useful in the management of cystitis

Drug adherence and drug-related problems in pharmacotherapy for lower urinary tract symptoms related to benign prostatic hyperplasia.

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is one of the most common urinary disorders in elderly men. In recent years, pharmacotherapy of BPH has increased the efficacy, including combination treatment mostly with two drug classes, namely, 5-α-reductase inhibitors and α-1-adrenolytics (alpha blockers) with a different pharmacological activity. Although pharmacological treatment of BPH is a success story in urology, daily practice suggests that several medical needs remain unmet. We aimed to evaluate drug adherence in patients receiving pharmacological therapy to treat LUTS/BPH, and to analyze drug adherence among monotherapy and combination therapy. The sample population consisted of 758 men aged > 40 years who had been prescribed medications for LUTS/BPH during the index period between June 2015 and August 2016. Only alpha blockers and 5-α-reductase inhibitors (5ARIs) were considered in the analysis. Among ABs there were doxazosin, tamsulosin, alfuzosin, terazosin and among 5-α-reductase inhibitors it was only finasteride. Drug adherence was assessed in patients who were treated for a minimum of 6 months. Two levels of exposure were evaluated, follow-ups: ≥ 6 months, and ≥ 12 months. In patients who were treated for at least 6 months, the drug adherence rate was 32% and the 12-month drug adherence rate was 23%. We observed an inverse relationship between drug adherence rates and the duration of treatment - longer the duration of pharmacological therapy, lower was the drug adherence rate noted. Our study shows a low rate of overall drug adherence in patients diagnosed with BPH. It was observed that a low adherence rate is closely related to drug-related problems (DRP). Furthermore, this is a correlation between the degree of LUTS/BPH and adherence rate - the higher degree of LUTS/BPH, the higher adherence rate. Further studies are warranted focusing on assessing adherence to pharmacological therapy.

MP13-04 SPORADIC PRIMARY HYPERPARATHYROIDISM AND STONE DISEASE: A COMPREHENSIVE METABOLIC EVALUATION BEFORE AND AFTER PARATHYROIDECTOMY

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I1 Apr 2018MP13-04 SPORADIC PRIMARY HYPERPARATHYROIDISM AND STONE DISEASE: A COMPREHENSIVE METABOLIC EVALUATION BEFORE AND AFTER PARATHYROIDECTOMY Giovanni Marchini, Kauy Faria, Fabio Torricelli, Manoj Monga, Fabio Vicentini, Alexandre Danilovic, Miguel Srougi, William Nahas, and Eduardo Mazzucchi Giovanni MarchiniGiovanni Marchini More articles by this author , Kauy FariaKauy Faria More articles by this author , Fabio TorricelliFabio Torricelli More articles by this author , Manoj MongaManoj Monga More articles by this author , Fabio VicentiniFabio Vicentini More articles by this author , Alexandre DanilovicAlexandre Danilovic More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , William NahasWilliam Nahas More articles by this author , and Eduardo MazzucchiEduardo Mazzucchi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.476AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES to characterize the stone risk and the impact of parathyroidectomy on the metabolic profile of patients with primary hyperparathyroidism (PHPT) and urolithiasis. METHODS We analyzed the prospectively collected charts of patients treated at our stone clinic from Jan/2001-Jan/2016 searching for patients with PHPT and urolithiasis. Imaging evaluation of the kidneys, bones and parathyroid glands were assessed. We analyzed the demographic data, serum and urinary parameters before and after parathyroidectomy. Statistical analysis included paired T/Fisher/Spearman/ANOVA tests. Significance was set at p<0.05. RESULTS 51 patients were included. Mean age was 57.1±12.1years and 82.4% were female. Hypercalcemia was present in 84.3% of patients (Table 1). All eight patients with normal calcium had elevated PTH. Only two subjects did not have PTH above normal range, though both had elevated calcium. Before parathyroidectomy, mean calcium and PTH levels were 11.2±1.0mg/dL and 331±584pg/dL, respectively (Table 2). The most common urinary disorders were low urinary volume (64.7%), hypercalciuria (60.8%), high urinary pH (41.2%) and hypocitraturia (31.4%). After parathyroidectomy, the number of patients with hypercalcemia (n=4;7.8%), elevated PTH (n=17;33.3%) and hypophosphatemia (n=3;5.9%) significantly decreased (p<0.001). The number of urinary abnormalities decreased and there was a reduction in urinary calcium levels (p<0.001), pH (p=0.001) and citrate (p=0.003). A negative significant correlation was found between PTH and urinary calcium (R=-0.304; p=0.04). CONCLUSIONS Individuals with PHPT and nephrolithiasis frequently present elevated baseline PTH and calcium. Low volume, hypercalciuria, high urinary pH, and hypocitraturia are the most frequent urinary disorders. Parathyroidectomy is effective in normalizing serum calcium and PTH levels, though other urinary metabolic may persist. Patients should be monitored for the need for citrate supplementation. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e172 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Giovanni Marchini More articles by this author Kauy Faria More articles by this author Fabio Torricelli More articles by this author Manoj Monga More articles by this author Fabio Vicentini More articles by this author Alexandre Danilovic More articles by this author Miguel Srougi More articles by this author William Nahas More articles by this author Eduardo Mazzucchi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Sporadic primary hyperparathyroidism and stone disease: a comprehensive metabolic evaluation before and after parathyroidectomy.

To characterize the stone risk and the impact of parathyroidectomy on the metabolic profile of patients with primary hyperparathyroidism (PHPT) and urolithiasis. We analysed the prospectively collected charts of patients treated at our stone clinic between January 2001 and January 2016 searching for patients with PHPT and urolithiasis. Imaging evaluation of the kidneys, bones and parathyroid glands was assessed. We analysed the demographic data, serum and urinary variables before and after parathyroidectomy. We used a paired t-test, Fisher's test, Spearman's test and anova in the statistical analysis. A total of 51 patients were included. The mean patient age was 57.1 ± 12.1 years and 82.4% were women. Before parathyroidectomy, mean calcium and parathyroid hormone (PTH) levels were 11.2 ± 1.0 mg/dL and 331 ± 584 pg/dL, respectively. Hypercalcaemia was present in 84.3% of patients. All eight patients with normal calcium levels had elevated PTH levels. Only two patients did not have PTH above the normal range, although both had elevated calcium levels. The most common urinary disorders were low urinary volume (64.7%), hypercalciuria (60.8%), high urinary pH (41.2%) and hypocitraturia (31.4%). After parathyroidectomy, the number of patients with hypercalcaemia (n = 4; 7.8%), elevated PTH (n = 17; 33.3%) and hypophosphataemia (n = 3; 5.9%) significantly decreased (P < 0.001). The number of urinary abnormalities decreased and there was a reduction in urinary calcium (P < 0.001), pH (P = 0.001) and citrate levels (P = 0.003). Individuals with PHPT and nephrolithiasis frequently have elevated baseline PTH and calcium levels. Low volume, hypercalciuria, high urinary pH, and hypocitraturia are the most frequent urinary disorders. Parathyroidectomy is effective in normalizing serum calcium and PTH levels, although other urinary metabolic may persist. Patients should be monitored for the need for citrate supplementation.

The female urinary microbiota, urinary health and common urinary disorders.

This review provides the clinical context and updated information regarding the female urinary microbiota (FUM), a resident microbial community within the female bladder of many adult women. Microbial communities have variability and distinct characteristics in health, as well as during community disruption (dysbiosis). Information concerning characteristics of the FUM in health and disease is emerging. Sufficient data confirms that the microbes that compose the FUM are not contaminants and are cultivatable under appropriate conditions. Common clinical conditions, including urinary tract infection (UTI) and urgency urinary incontinence (UUI), a common form of urinary incontinence (UI), may be usefully reconsidered to determine the role of the FUM. Knowledge of FUM characteristics may help advance prevention, diagnosis and treatment of these conditions and other common lower urinary disorders in women. The FUM appears related to UTI and UUI in adult women. The specific role of the FUM remains to be clarified and requires significant additional work in describing FUM variability and resilience in health. Unique aspects of the FUM prompt re-evaluation of existing nomenclature to more appropriately define health and disease; the concept of dysbiosis may be useful for understanding the interaction of the FUM with other aspects of lower urinary tract physiology, including urothelial signaling. Clinicians, through their clinical laboratories, can adopt enhanced urine culture techniques that more fully describe the living microbes within the FUM. This additional information may provide clinicians and their patients an opportunity to impact clinical care without antibiotic use, if the FUM can be appropriately modified to improve treatment precision for UTI and UUI.

Quantification of Nighttime Micturition With an Ambulatory Sensor-Based System.

Among elderly males, benign prostate syndrome (BPS) is the most common urinary disorder. Nocturia is one of the major symptoms of BPS and has a considerable influence on the quality of life. For assessment of BPS (including nocturia), the International Prostate Symptom Score is widely used, but questionnaires are prone to bias. To date, there is no objective measurement system available for nocturia. In this study, we present an unobtrusive and nonstigmatizing device for objective measurement of nighttime micturition. In a preliminary study of six males diagnosed with BPS and nighttime micturition ≥ 2×, we showed that the device is accurate, with an average misdetection rate of 0.32 events and a mean absolute deviation of 3.8% when comparing the average number of nighttime micturition occurrences. In this extended study, an additional nine males were recorded and data from an occupancy sensor were also included. The results of the preliminary study were confirmed with an average misdetection rate of 0.33 events and a mean absolute deviation of 9.1%. The system can, therefore, be used to objectively measure nighttime micturition and, thereby, provide the basis for treatment, e.g., medication efficacy assessment.

Phytotherapeutical Alternatives for the Treatment of Benign Prostatic Hyperplasia in Obesity

Benign prostatic hyperplasia is a very common urinary disorder affecting middle-aged men, giving place to lower urinary tract symptoms, which are detrimental to the quality of life. Obesity increases the risk and severity of its symptoms requiring earlier medical interventions for its treatment. Current pharmacotherapy has serious adverse effects that can lead to discontinuation of the treatment. Phytotherapy is an alternative being used in European countries for sev- eral years; however, the evidence for its efficacy is contradictory and remains to be clearly defined. It is of transcendental importance to homogenize quality of plant extracts, as well as to test them in specific age groups to obtain evidence whether plant extracts alone or in combination have the potential to serve as the only therapy or as adjuncts with more tra- ditional treatments for BPH. This review also assesses the fact that no clinical trials have been performed in obese pa- tients, despite the direct link between obesity and prostate disease.

Evaluation of the clinical indications, adverse drug reactions, and finasteride use in patients with benign prostatic hyperplasia in Poland

BackgroundBenign prostatic hyperplasia (LUTS/BPH) is one of the most common urinary disorders in elderly men. The symptoms of the disease include prostate gland enlargement, bladder outlet obstruction, and lower urinary tract symptoms (LUTSs). BPH predisposes patients to bladder infections and bladder stone formation and increases their risk of urinary retention, which in turn causes renal failure. Hence, the disease requires surgical treatment. However, over the recent years, the number of surgical interventions performed in pharmacotherapy has significantly reduced because of the increased efficacy of conservative therapy, including combination treatment mostly with 2 groups of drugs, namely, alpha-1-adrenolitics and other 5-alpha-reductase blockers, with a different pharmacological activity [5].The aim of this study was to evaluate the clinical indications, adverse drug reactions, and finasteride use in patients with diagnosed BPH in Poland. Materials and methodsWe conducted a clinical trial from November 2009 to November 2010 that included 5751 patients who were enrolled in 46 urological centres in Poland. The researchers who conducted the clinical trial were urologists from different regions of Poland. The clinical trial involved 6 follow-up visits. The mean age of the patients was 67 years (range, 45–93 years; median, 67.00; SD, 8.507). The inclusion criteria were as follows: LUTSs, finasteride therapy for at least 2 weeks, age>40 years, and BPH. ResultsPatients self-reported data on LUTSs, the symptom frequency, concurrent diseases, and intensification of urinary system symptoms. In addition, additional examinations were performed, including prostate-specific antigen test, urinary tract ultrasonography with evaluation of residual urine and prostate, and uroflowmetry. The study did not exclude data on the combined treatment with finasteride and alpha-1-adrenolitics. ConclusionFinasteride was demonstrated to be effective, as evidenced by the significant decrease in TPV by 40% even after 12 months. It was also found to contribute to the attenuation of LUTSs, improvement in maximum flow rate, decrease in nocturia, and improvement in QoL.

Finasterid in der Behandlung der benignen Prostatahyperplasie

Benign prostatic hyperplasia (BPH) is one of the most common urinary disorders in elderly men. The symptoms of this disease are increased prostate size, bladder outlet obstruction and lower urinary tract disorders. It influences bladder infections, bladder stone formation and increases the risk of urinary retention which can cause renal failure. It is necessary for the disease to be treated operatively. The number of conducted surgical interventions for pharmacotherapy has been significantly reduced in recent years due to increased efficacy in conservative therapy including combined treatment mostly with two groups of drugs: finasteride and alpha-blockers with different pharmacological activities. The aim of the study was to evaluate finasteride efficacy in the treatment of benign prostatic hyperplasia. The clinical trial was conducted from October 2008 to November 2009. According to the urologist's recommendation the patients took finasteride at a dose of 5 mg daily. A total of 4,315 patients participated in the clinical trial and were enrolled in 50 urological centres in Poland. The average age of the patients was 66.5 years, the youngest patient was 46 and the oldest was 91 (median 67.00 years, standard deviation SD±8.101). The use of finasteride at least for 2 weeks was the criterion for the patient to be included in the study. The medical trial lasted 12 months and consisted of 6 visits at which data relating to IPSS, QoL, intensification of urinary system symptoms, the results of the additional studies, PSA serum concentrations, the urinary tract USG with evaluation of residual urine and prostate, urine analysis with evaluation of crystalline, uroflowmetry, transrectal ultrasonography (TRUS) and biopsy were recorded. The study did not exclude the combined treatment with finasteride and alpha-adrenergic blocking drugs. Prostatocystitis was diagnosed in 30 men among the patients treated at the first visit after the digital rectal examination (DRE) trial and they qualified for antibiotic therapy. Suspicion of a tumor was diagnosed in 69 (1.59 %) patients of the study group at the first visit after the DRE trial and they qualified for biopsy of the prostate after the PSA trial and TRUS at the second visit. Therefore, 4,216 patients took part in the clinical trial. In the course of 12 months 392 patients were excuded from the study for different reasons: cardiac infarct, apoplexy, resignation without reason and change of address. According to the IPSS scale (International Prostate Symptom Score) a small intensification of symptoms was diagnosed in 676 patients (16%), in 2,830 patients (67%) moderate and in 718 patients (17 %) considerable. Prostate cancer was confirmed histopathologically in 50 (1.15%) out of 69 patients who qualified for biopsy of the prostate. In 2,677 (70%) patients taking both alpha-blocker and finasteride, the progression of disease reduced, the micturation improved considerably and the mass of adenoma of the prostate diminished by 40%. However, in 956 (25%) patients taking only finasteride or finasteride + phytotherapy the mass of adenoma of the prostate diminished by 40%, too. When the medical trial was finished, 212 patients (5.02 %) of the study group who showed intensive symptoms of BPH and the finasteride and alfa-blocker treatment proved not to be effective enough qualified for surgical therapy. A total of 3,824 out of 4,216 (90.7%) patients finished the medical trial and 3,612 (85.6 %) were willing to continue the further therapy.

Urologic Disorders of the Geriatric Dog

Disorders of the urinary system are common in geriatric dogs. Common urinary disorders that are seen in older dogs include chronic renal failure, urinary incontinence, bladder tumors, and prostate problems. Therapy for chronic renal failure is aimed at both slowing the progression of the disease and ameliorating the signs of uremia. Therapeutic recommendations for the conservative medical management of chronic renal failure include reducing dietary protein, moderately reducing salt intake, maintaining normal serum phosphorus levels, providing free access to water, avoiding stress, supplementing water soluble vitamins, using anabolic steroids to treat the anemia of chronic renal failure, treating acidosis, and controlling hypocalcemia. Urinary incontinence can often be controlled or eliminated. The appropriate approach to management of this disorder is to identify and remove specific causes. Common causes of urinary incontinence are urethral incompetence, urinary tract infection, and polyuria and polydypsia. Bladder tumors are, fortunately, not a common tumor of dogs, but are more common in geriatric dogs than in the young. The most common bladder tumor is the transitional cell carcinoma. Therapy for this tumor is usually palliative because of its malignant nature and because it is usually located in the neck of the bladder. Its location in the bladder often makes it impossible to resect the tumor completely without removing the entire bladder and diverting the ureters. New chemotherapeutic modalities are being evaluated that may increase life expectancy after diagnosis and, therefore, improve prognosis. Prostate disease is also seen in older dogs. Types of prostate abnormalities seen in dogs include prostatic hyperplasia, cysts, abscesses, acute and chronic infection, and neoplasia. The institution of proper therapy requires an accurate diagnosis; neutering is often recommended as a part of therapy regardless of the type of prostatic disease present.

645 - The Use of Urodynamics in Common Urinary Disorders

No AccessJournal of Urology1 Jun 1987The Use of Urodynamics in Common Urinary Disorders Hector Bensimon Hector BensimonHector Bensimon More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)75795-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "The Use of Urodynamics in Common Urinary Disorders." The Journal of Urology, 137(6), p. 265A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 265A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Hector Bensimon More articles by this author Expand All Advertisement PDF DownloadLoading ...