Common Urinary Symptoms Research Articles

Impact of Overactive Bladder and Dry Mouth on Subjective and Comprehensive Sleep Quality in Older Adults With Nocturia.

Nocturia is among the most common and bothersome urinary tract symptoms in older adults. While sleep quality is key to nocturia management, there is little information on the impact of nocturia itself on sleep quality. We investigated the impacts of nocturia on sleep quality and quality of life and explored factors contributing to reduced sleep quality. A total of 186 men, aged 42-88 years (patients with nocturia and a control group), were evaluated using the Pittsburgh Sleep Quality Index, the Nocturia Quality-of-Life questionnaire, a visual analog scale measurement of dry mouth, and the Overactive Bladder Symptom Score, among other tools. Patients were graded into four categories of nocturia severity based on 3-day frequency volume charts. Factors associated with reduced subjective and comprehensive sleep quality were investigated using multiple regression analysis. Initial undisturbed sleep duration was negatively associated with nocturia frequency. Subjective and comprehensive sleep quality, overactive bladder scores, sleep efficiency and oral dryness were significantly associated with nocturia-related quality of life, when controlled for both age and nocturia severity. Sleep efficiency was a major predictor of reduced subjective and comprehensive sleep quality; overactive bladder scores and oral dryness were also independently significantly associated with reduced subjective and comprehensive sleep quality on multiple regression analysis, although nocturia frequency and initial undisturbed sleep duration were not. It may be beneficial to conduct a comprehensive assessment for overactive bladder and dry mouth when managing nocturia in older adults with poor sleep quality.

Symptomatology and level of satisfaction in patients using the double‐J ureteral stent

AbstractBackgroundUreteral stents are used as temporary or permanent drainage measures for intrinsic or extrinsic occlusions of the upper urinary tract. Their use can cause complications such as urinary symptoms, which consequently impact the quality of life. Therefore, the aim of this study was to analyze the symptoms and level of satisfaction of patients who used the double‐J ureteral stent.MethodsThis article is a cross‐sectional study involving 40 volunteers who had previously undergone a urological procedure that required the insertion of a double‐J ureteral stent. Subsequently, they consulted the urology outpatient clinic and answered a questionnaire designed by the authors.ResultsAccording to the results, the average age of the patients was 43 years old, 75% were female, and 42.5% reported comorbidities, with hypertension being the most prevalent. The wired double‐J ureteral stent was used in 72.5% of patients, and the average length of stay was 6 days. 95% of the patients had complaints related to the use of the double‐J ureteral stent, with colicky abdominal pain being the most frequent symptom (77.5%) and hematuria being the most common urinary symptom (65%), followed by dysuria (62.5%) and urgency (52.5%). Analysis of the level of satisfaction showed that 55% of patients were satisfied and 22.5% were dissatisfied. No statistical significance was found between the incidence of symptoms related to the double‐J ureteral stent and the groups analyzed.ConclusionThis study was able to highlight important features of the symptomatology of patients using the double‐J ureteral stent and the repercussions on satisfaction with its use. Furthermore, it was possible to concluded that the experience of using the double‐J ureteral stent was satisfactory for 55% of the patients.

A pharmacist-driven deprescribing protocol for negative urine and sexually transmitted infection cultures in the emergency department increases antibiotic-free days.

Emergency department (ED) pharmacists commonly perform positive culture follow-ups that result in optimized antibiotic prescribing. The purpose of this study was to evaluate the potential positive impact on the outcome of antibiotic-free days through an ED pharmacist-driven protocol to contact patients with negative urine cultures and sexually transmitted infection (STI) test results who were discharged with antibiotics. This was a single-center, prospective, observational, pre-post intervention study to determine antibiotic use in patients with negative urine cultures who were discharged from the Loyola Medical University Center ED with antibiotics prescribed. Patients were identified through daily positive culture reports. The primary outcome was days free of antibiotics, defined as the number of calendar days within 28 days after urine culture or STI test collection on which the patient did not receive any antibiotic treatments. One hundred ninety-two patients were screened. Sixty-three and twenty-six patients met the inclusion criteria in the pre- and postintervention groups, respectively. The study identified 163/465 (35.1%) antibiotic free days for the preintervention group, compared to 150.5/187 (80.5%) antibiotic-free days for the postintervention group. A majority of the patients did not have urinary tract infection as the chief complaint. The most common urinary and STI symptoms upon ED admission in the pre- and postintervention groups were dysuria (19.2% vs 28.1%) and unusual discharge (30.8% vs 28.6%), respectively. This study showed that a pharmacist-driven protocol increased the number of antibiotic-free days for patients prescribed empiric antibiotic therapy and discharged from the ED with subsequent negative urine cultures and STI results. We propose taking a novel approach in discontinuation of antibiotics by implementing an expansion of ED culture programs to include negative cultures that promote antimicrobial stewardship.

Эффективность и безопасность интермиттирующей катетеризации для купирования острой задержки мочи: проспективное сравнительное рандомизированное исследование

of the study: to evaluate the effectiveness and safety of intermittent catheterization in the management of acute urinary retention and to identify factors influencing the resume normal voiding and the development of adverse events.129 patients admitted to urology department with acute urinary retention due to BPH were randomized into two groups. Group I had indwelling bladder catheterisation using Foly catheter. Group II was catheterized intermittently.Success rate, time to resume normal voiding, number of episodes of fever, pain, urgency and gross hematuria. Factors influencing the probability of AUR resolution and adverse events were also analyzed.Normal voiding was resumed in 25 (35.7%) patients in group I, and in 26 (44%) patients in group II. The probability of AUR resolution in group II was 1.5 times higher than in group I. However, this difference was not statistically significant. In group II normal voiding was restored within 1 day in 1 (3.8%) patient, in 12 (46.2%) - within 2 days, and in 13 (50%) - within 3 days. On the 7th day relapse of AUR occurred in 3 (2.3%) patients, in 2 (2,8%) patients in group I and in 1 (1.7%) patient in group II. Logistic regression analysis showed statistically significant association between the probability of developing gross hematuria and the age of the patient, as well as between possible urethrorrhagia and episodes of acute urinary retention previous to the last AUR episode. Statistically significant associations were revealed between age and the use of a-blockers at the time of the acute urinary retention episode and the probability AUR resolution. An increase in the patients age by 1 year was associated with decrease in the chances of voiding resumption by 1.07 times, and a-blockers therapy at the time of acute urinary retention increased these chances by 2.8 times. Urgency rate was statistically significantly higher in group I (30% vs. 3.4%), the chances of developing urgency were also 12 times higher in group I.Intermittent catheterization is an effective method of AUR management. The major advantages of this method are the possibility of outpatient treatment, maximum preservation of patients social and sexual activity, earlier resumption of voiding and significantly less common catheter-associated lower urinary tract symptoms.

Effect of perioperative pelvic floor muscle training program on incontinence and quality of life after radical prostatectomy: A randomized controlled trial

Objective The aim of this study was to evaluate the effect of a perioperative pelvic floor muscle training program on urinary incontinence symptoms and the quality of life of patients after radical prostatectomy. Methods This single-center, parallel-group, randomized, controlled study was conducted with a total of 60 patients undergoing open radical prostatectomy in a training and research hospital in Turkey. Patients were randomly assigned to the pelvic floor muscle training group (n = 30) and the control group (n = 30). The data were collected by face-to-face and phone interviews following surgery at seven days after removal of the urethral catheter (baseline) and 3 months using the Patient Information Form, the International Consultation on Incontinence Questionnaire Short Form and the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. Descriptive statistics, Chi-square test, Independent-samples t-test, and paired-samples test were used to analyze the data. Primary and secondary endpoints were the differences between groups in terms of both scale scores after 3 months. Findings After 3 months, Incontinence Questionnaire Short Form scores (P < 0.001) and “voiding, incontinence, frequency, nocturia” symptoms scores (P < 0.001) were significantly lower in the pelvic floor muscle training group, and quality of life scores were higher than in the control group (P < 0.001). Conclusion According to this study, the perioperative pelvic floor muscle training program was effective on patients’ urinary incontinence symptoms and quality of life 3 months after radical prostatectomy. Evidence-based practices should be used for patients to alleviate common urinary symptoms and to accelerate the recovery of urinary continence.

The impact of myasthenia gravis on lower urinary tract functions.

To assess the functions of the lower urinary tract (LUT) in patients with myasthenia gravis (MG). A total of 36 patients (18 males and 18 females) with MG and 29 healthy controls were enrolled. Participants completed a 3-day voiding diary and responded to questionnaires "Overactive Bladder Symptom Score" (OABSS) and "International Consultation on Incontinence-Short Form" (ICIQ-SF). All patients underwent uroflowmetry and ultrasonography (US). The data were compared based on the onset of disease and serological status. The most common urinary symptoms were nocturia (80.5%), incontinence (61%) and urgency (47%). OABSS was higher in patients than controls (P=.008). Duration of urinary symptoms was longer, and nocturia was more common in late-onset MG (LOMG) than in early-onset MG (EOMG; P=.029, P=.023). The duration of disease and urinary symptoms statistically increased in ACh-Ab (-) group compared with ACh-Ab (+) group (P=.003, P=.027). Night-time urination frequency significantly increased while daytime voided volume (VV) decreased in LOMG compared with EOMG (P=.003 and P=.01). Residual volume on the US was significantly higher in LOMG than that in EOMG (P=.004). The duration of disease was positively correlated with tQmax and daytime urination frequency (P=.013, r=.48; P=.016, r=.398). A negative association was found between duration of disease and daytime VV (P=.04, r=-.344). LUT dysfunction may manifest disease in MG, particularly in late-onset forms. The lack of ACh-Ab seemed to prolong the duration of disease and urinary disturbances.

Dysuria and medical events related to heat stress and muscle injury among male Nicaraguan sugar cane workers

Background. Nicaraguan sugar cane workers have an elevated prevalence of chronic kidney disease of unknown origin (CKDu). CKDu pathogenesis may involve environmental heat exposure along with generation of mechanical heat, providing an opportunity for recurrent heat stress and muscle injury with subsequent kidney injury. A common urinary symptom among at-risk workers is dysuria. Compared with other job types, cane cutters may be at elevated risk of these potential intermediate events, though longitudinal studies are limited.Methods. Using employment data for male workers at a Nicaraguan sugar cane company, we classified active work months as cane cutting or non-cane cutting for each month of follow-up, July 1993 through June 2010. Based on medical records, we determined occurrence of: dysuria, heat-related events, and muscle-related events during follow-up. Dysuria was defined as pain upon urination without other explanatory cause. Heat-related events included heat stress or experiencing &gt;=2 heat symptoms. Muscle-related events were defined to identify potential rhabdomyolysis. Associations between cane cutting and each outcome were analyzed using logistic regression based on generalized estimating equations for repeated events, controlling for age.Results. The 242 workers contributed 13,530 active work months, with 22.4% of person-months classified as time worked in cane cutting. There were 376 dysuria events, 35 heat-related events, and 32 muscle-related events. Cane cutting months exhibited a higher odds of dysuria and heat-related events [dysuria: OR=1.67 (95% CI: 1.18-2.37); heat: 1.97 (0.92-4.22)] compared with non-cane cutting months. The associations with cane cutting strengthened after subjects had worked &gt;=60 months [dysuria: OR=2.70 (95% CI: 1.72-4.24); heat: 3.05 (1.22-7.61)]. No association was observed for muscle-related events.Conclusions. Working in cane cutting compared with working in a different job was associated with increased dysuria and heat-related events, supporting the hypothesis that cane cutters are at increased risk of events suspected of inducing or presaging CKD.

Can patients independently identify their urinary incontinence symptoms?

The objective of our study is to compare patient self-reported urinary incontinence symptoms based on the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF) question number 6 (When does urine leak?) with physician-assessed interpretation of the patient's urinary incontinence symptoms. This trial is a cross-sectional study of patients who presented to a tertiary urogynecology center with symptoms of urinary incontinence between January 2014 and August 2016. We compared patient-reported symptoms on the ICIQ-SF with physician interpretation of urinary complaints during their initial visit. The urinary incontinence symptoms included stress urinary incontinence (SUI), urgency urinary incontinence (UUI), insensible urine loss, nocturnal enuresis, and post-micturition dribbling. A total of 432 patients with a mean age of 61 were included in this evaluation. The most common urinary incontinence symptoms according to the physician were UUI (n = 357, 83%), followed by SUI (n = 308, 71%). Of the patients who were diagnosed by a physician with the symptom of UUI, only 61% self-identified as having this symptom based on the ICIQ-SF, and for SUI, only 66% self-identified as having SUI symptoms based on the ICIQ-SF. Overall UUI (κ = 0.30) appears to have poor agreement, as does nocturnal enuresis (κ = 0.39), when compared with physician historical assessment. There is a discrepancy between patient-reported urinary incontinence symptoms on the ICIQ-SF and physician-assessed symptoms. Symptomatology entered into electronic medical records by patients is often inaccurate. Physician validation is essential in understanding the underlying the precise symptomatology.

MP35-03 CONSERVATIVE MANAGEMENT OF LICHEN SCLEROSUS-INDUCED MALE URETHRAL STRICTURES

INTRODUCTION AND OBJECTIVE: Lichen sclerosus-induced urethral stricture disease (LS-USD) creates surgical challenges for the reconstructive urologist due to the high risk of stricture recurrence and disease progression. We reviewed the outcomes of such patients at our institution to determine if conservative management can be an effective strategy. METHODS: We retrospectively identified patients with LS-USD who were managed with urethral balloon dilation or clean intermittent catheterization (CIC) +/- intraurethral steroids. Any patient who had an obliterative stricture, underwent urethral reconstruction as the primary means of USD treatment, or had less than 3 months follow-up was excluded. Primary outcome measures were urinary tract infection (UTI), acute urinary retention (AUR), serum creatinine, and uroflowmetry values. Secondary outcome measures were Sexual Health Inventory for Men (SHIM) and Male Sexual Health Questionnaire (MSHQ) scores. RESULTS: A total of 109 men met inclusion criteria between 2005-2019 with a median follow-up of 24 months (IQR 8-49). Median age was 52.2 years, body mass index was 35.5 kg/m2, and Charlson comorbidity index was 1. Median stricture length on retrograde urethrogram was 10 cm (IQR 2-20). Stricture location was: meatus/fossa navicularis (33%), pendulous (9%), and bulbopendulous (58%). The most common urinary symptoms were slow flow (50%), sitting to void (25%), and spraying (23%). A total of 77 (71%) patients underwent subsequent urethral dilation. Median number of dilations per patient was 1 (IQR 1-3). CIC was utilized in 32% of patients, with 32% of this subgroup applying steroids intraurethrally via CIC. Uroflowmetry values and sexual health questionnaires showed no significant change between first and last visits (Table 1). Median serum creatinine at first and last visits remained unchanged at 1.0 mg/dL. Eight (7%) patients had an AUR episode requiring urgent treatment and 20 (18%) had a stricture-related UTI. CONCLUSIONS: Although certain patients will desire or require urethral reconstruction, many patients with LS-USD, across a wide range of stricture lengths and locations, appear to be safely managed with urethral dilation or CIC +/- intraurethral steroids. Close observation is warranted due to the risk of stricture-related UTIs and AUR episodes.Source of Funding: None

Depression, lower urinary tract symptoms and quality of life in women with multiple sclerosis: A descriptive and correlational study

Background: Among the most ordinary clinical manifestations of Multiple Sclerosis (MS) are depression and the presence of Lower Urinary Tract Symptoms (LUTS). Both can compromise a person’s quality of life. Objective: The objective of this research was to identify the major urinary symptoms and correlate them with quality of life and with depressive symptoms in women with MS. Methodology: This was an observatory, descriptive and correlational study, with non-probabilistic sampling by convenience. This research included women over 18 years old who displayed LUT symptoms and who had been diagnosed with Relapsing-Remitting MS. Assessment consisted of an anamnesis card, the Kurtzke Expanded Disability Status Scale (EDSS), the Incontinence Impact Questionnaire-7 (IIQ-7-BR), the Urogenital Distress Inventory-6 (UDI-6-BR), the Beck Depression Inventory-2 (BDI-II) and the Multiple Sclerosis Quality of Life Questionnaire - Portuguese version (MSQOL-54). Results: 41 women participated in the study, with average age of 50.1 (± 9.45) and average of 4.11 in the EDSS. The most common urinary symptom was urinary urgency (78%). There was no correlation between the severity of the urinary symptom and quality of life. Moderate and significant negative correlation (r = -0.561 p<0.001) was found between depression and the physical component of quality of life and strong negative correlation (r = -0.729 p<0.001) was found between depression and the mental component. Conclusions: The most prevalent urinary symptom was urinary urgency. A strong correlation was found between symptoms of depression and quality of life and there was no correlation between urinary symptoms and quality of life. Keywords: Multiple sclerosis; urinary incontinence; quality of life; depression

A prospective study of uroflowmetry in 100 patients with lower urinary tract symptoms

Background: Uroflowmetry is diagnostic procedure of various urinary tract diseases like urethral stricture, benign prostatic hyperplasia, neurogenic bladder, detrusor muscle overactivity by calculating the rate of urine expulsion against the time unit in second. Uroflowmetry is simple and non-invasive diagnostic method.Methods: This is a prospective study of 100 cases which fulfil inclusion and exclusion criteria. After taking informed written consent of the patients, they have gone under uroflowmetry study by Urocap 3 uroflowmeter, and graphs were obtained and result analysed.Results: Maximum number of patients has prolonged curve graph were diagnosed as benign prostate hypertrophy (BPH) (53%), dysfunctional voiding curve for detrusor overactivity (20%) intermittent flow curve for neurogenic bladder (7%), Box variety for urethral stricture (7%).Conclusions: In present study we found that uroflowmetry is helpful in diagnosis of certain urological pathologies. Common lower urinary symptoms were burning micturition, frequency and difficulty in micturition. Age group from 50-70 years was often presented with bladder outflow obstruction. Uroflowmetry overall useful in diagnosis of BPH and urethral stricture which can be supported by ultrasonography of prostate with PVRV and RGU respectively to avoid other invasive and more difficult pressure or flow urodynamic study.

Management of Urinary Incontinence in Older Adults in Rehabilitation Care Settings

This review focuses on updates in the management of urinary incontinence occurring in older adult populations living with conditions frequently managed by physical medicine and rehabilitation specialists. Urinary incontinence is common among older adults who live with neurologic diseases, such as stroke, Parkinson’s disease, multiple sclerosis, and traumatic brain injury, and may be cared for in outpatient and acute rehabilitation facilities. While the evidence is growing regarding treatment strategies specific to patients with neurogenic bladder, behavioral treatment approaches may be a viable first option depending on cognitive status and mobility. Drug therapy choices should consider mechanism of action and formulation to minimize the potential for adverse effects. Minimally invasive strategies provided by continence specialists are available for refractory symptoms. Evidence suggests a multidisciplinary approach incorporating multicomponent treatment strategies can improve common urinary symptoms among older adults in both outpatient and acute inpatient rehabilitation settings of care.

Genitourinary Dysfunction Prevalence in Parkinson Disease Patients

Abstract The goal of this study was to estimate the prevalence of patient-reported genitourinary dysfunction symptoms in Parkinson’s disease patients from the Southeastern Romania. The study was performed on 86 patients with idiopathic Parkinson’s disease from 5 Outpatients Clinics of Constanta, 56% males, mean age 70.6 years, mean disease duration 6.33 years. The patients have been assessed for the presence of genitourinary symptoms using the Scale for Outcomes in Parkinson’s Disease for Autonomic Symptoms (SCOPA-AUT) as a self-administered questionnaire. The vast majority of study population (98.8%) reported at least one genitourinary dysfunction. The most common urinary symptom was nocturia (95.3%, 95% CI 90.8-99.7), followed by pollakiuria (82.5%, 95% CI 74.4-90.5), difficulty passing urine and urge to urinate (each present in 76.7% of studied PD patients, 95% CI 67.4-85.3), incomplete bladder emptying (75.5%, 95% CI 66.4-84.5), urinary incontinence (67.4%, 95% CI 57.5-77.3). As frequency, most of the study subjects experienced genitourinary symptoms only “sometimes”. None of the investigated PD patients affected by genitourinary symptoms used specific medication therapy.

Factors Affecting Diagnostic Timeliness and Safety in Symptomatic Patients Subsequently Diagnosed With Bladder and Kidney Cancer: A Systematic Review

Background: Timely diagnosis of cancer is important for good clinical outcomes and patient experience. Bladder and kidney cancer, being two relatively common cancers, can pose diagnostic challenges. Symptoms such as hematuria and urinary tract infections in some patients have a higher than 3% positive predictive value for cancer, a threshold above which English GPs are advised to consider the referral of patients for, under the 2015 NICE guidelines. However, the majority of patients with these symptoms will end up not having cancer. Therefore, the decision to perform further investigations or refer patients with these common urinary symptoms may differ despite the existence of guidelines. Studying in whom, and why, some patients may experience a longer than average time to diagnosis is important to understanding how avoidable diagnostic delay can be reduced, so that targeted interventions to improve early diagnosis can be developed to improve, ultimately, the outcome of these cancers. Aim: A systematic review was therefore performed to identify the factors that affect the diagnostic timeliness and safety of patients with urological symptoms that may be suggestive of kidney and bladder cancer. Methods: We searched Embase and Medline (Ovid) between 2000 and January 2018, for publications on symptoms/conditions including hematuria and urinary tract infection (UTI). We focused on clinical features that are listed in the English 2015 NICE guidelines for suspected cancer to examine the population that are most likely to have cancer, and in whom a timely diagnosis is the most crucial for outcomes. We also included symptoms that might be suggestive of a UTI (including dysuria, urinary frequency, urgency, incontinence and nocturia) to be overinclusive in our search. Results: Our initial search identified 7787 articles. Following title and abstract screening, 37 full texts were assessed for eligibility. A final 23 relevant studies were included. Our preliminary findings include evidence on patient, clinician and system factors contributing to diagnostic timeliness and safety issues (such as completeness of evaluation/investigations and referrals) in patients with possible urological cancer. These include patient sociodemographic factors (age, gender, ethnicity), clinician type (generalist, urologist vs gynecologist) and experience, and system factors such as delay in specialist appointment scheduling and patient no-shows. Conclusion: Our findings will provide a granular understanding of the factors contributing to avoidable diagnostic delay of patients with possible urological cancers globally. This is particularly important so that targeted interventions can be developed to help clinicians and health systems to better identify and manage at-risk patients with symptoms, so as to improve early diagnosis and outcomes of urological cancers.

Effet des traitements médicaux et chirurgicaux sur la nycturie de l’homme présentant une obstruction prostatique bénigne

Nocturia is the most frequently reported lower urinary tract symptom, but the impact of medical and surgical treatments on this symptom remains poorly evaluated. The objective of this work was to carry out a systematic review of the literature on the medical and surgical management of nocturia in men with bladder outlet obstruction due to benign prostatic hyperplasia. A systematic review of the literature was conducted including the effects of medical and surgical treatments on nocturia. Articles were selected by 3 independent reviewers before being analyzed and synthesized. Among medical treatments, the most effective on nocturia seems to be desmopressin. Nevertheless, prescribing restrictions to men under 65 years of age hinder its use in routine practice. The effect of other medical treatments remains modest, although significant compared to placebo groups. The decrease in the number of nocturia would decrease from 0.25 to 0.7 in placebo group and from 0.29 to 1.1 in active treatment groups (alpha blocker, diuretic, anti-inflammatory, IPDE-5, 5 alpha reductase inhibitor). Surgical treatments seem to be more effective on nocturia. Although persistent in half of the patients undergoing surgery, the number of nocturia episodes decreased in 70% of them. Nocturia is one of the most common urinary symptoms and the one that responds the least to the proposed medical and surgical treatments. The information given to patients by urologists must emphasize the modest effects to be expected in this area.

Results of a randomized, double blind, placebo controlled, crossover trial of melatonin for treatment of Nocturia in adults with multiple sclerosis (MeNiMS)

BackgroundNocturia is a common urinary symptom of multiple sclerosis (MS) which can affect quality of life (QoL) adversely. Melatonin is a hormone known to regulate circadian rhythm and reduce smooth muscle activity such as in the bladder. There is limited evidence supporting use of melatonin to alleviate urinary frequency at night in the treatment of nocturia. The aim of this study was to evaluate the effect of melatonin on the mean number of nocturia episodes per night in patients with MS.MethodsA randomized, double blind, placebo controlled crossover trial was conducted. 34 patients with nocturia secondary to multiple sclerosis underwent a 4-day pre-treatment monitoring phase. The patients were randomized to receive either 2 mg per night (taken at bedtime) of capsulated sustained-release melatonin (Circadin®) or 1 placebo capsule for 6 weeks followed by a crossover to the other regimen for an additional 6 weeks after a 1-month washout period.ResultsFrom the 26 patients who completed the study, there was no significant difference observed in the signs or symptoms of nocturia when taking 2 mg melatonin compared to placebo. The primary outcome measure, mean number of nocturia episodes on bladder diaries, was 1.8/night at baseline, and 1.4/night on melatonin, compared with 1.6 for placebo (Medians 1.70, 1.50, and 1.30 respectively, p = 0.85). There was also no significant difference seen in LUTS, QoL and sleep quality when taking melatonin. No significant safety concerns arose.ConclusionsThis small study suggests that a low dose of melatonin taken at bedtime may be ineffective therapy for nocturia in MS.Trial registration(EudraCT reference) 2012–00418321 registered: 25/01/13. ISRCTN Registry: ISRCTN38687869.

How Reliable is the Diagnosis Urinary Tract Infection (UTI) Using Common Urinary Symptoms Alone? – A Study of 300 Adult Females in a Primary Care Setting in Benin City, Edo State, Nigeria

How Reliable is the Diagnosis Urinary Tract Infection (UTI) Using Common Urinary Symptoms Alone? – A Study of 300 Adult Females in a Primary Care Setting in Benin City, Edo State, Nigeria

Postoperative urinary symptoms after transobturator tape in normal-weight compared with overweight and obese woman.

ObjectivesTo examine the clinical outcome of obesity in women who underwent the transobturator tape procedure for stress urinary incontinence and to compare postoperative urinary symptoms after transobturator tape surgery between normal-weight women and overweight and obese women.MethodsWe performed a retrospective cohort study of the risk of postoperative urinary symptoms, including recurrence after transobturator tape surgery, in normal-weight women compared with overweight and obese women at our institution from January 2009 through October 2011. We compared the body mass index (BMI) among the four groups. The primary outcome was the occurrence of postoperative urinary symptoms.ResultsThree hundred ten patients who underwent transobturator tape surgery were reviewed. At the 1-year follow-up, 281 women were analyzed: 89 (34%) normal-weight women, 78 (25%) overweight women, 101 (37%) obese 1 women, and 13 (3%) obese 2 women. There was a significant difference in the occurrence of postoperative urinary symptoms. They occurred in 3.4% (n=3) of normal-weight women, 5.1% (n=4) of overweight women, and 12.9% (n=13) of obese 1 women (P=0.038). The most common postoperative urinary symptom was frequent urination (n=14). There was a significant difference in leakage; it occurred in 1.1% (n=1) of normal-weight women, 3.9% (n=3) of overweight women, and 7.9% (n=8) of obese 1 women (P=0.139). Postoperative urinary symptoms were almost four times more likely to occur in obese 1 women than in normal-weight women.ConclusionTransobturator tape surgery seems effective regardless of BMI, but obese women had a higher occurrence of postoperative urinary symptoms than did normal-weight women.

Urinary disturbances and diabetes

The purpose of this study is to analyze the characteristics of urinary disturbances in diabetics, their impact on patient's life quality, and the influence of clinical and biological parameters on urinary symptoms. A cross-sectional study was conducted in Endocrinology department, on a group of 40 patients with type 1 or 2 diabetes. The clinical data included: weight, height and body mass index (BMI). The following laboratory data were obtained: fasting blood sugar, postprandial glycemia and glycosylated hemoglobin (HbA 1c ). Urinary Symptom Profile (USP) questionnaire was used to evaluate urinary disturbances and their impact on patient's life quality was assessed by Ditrovie scale. Thirty-six patients had urinary disturbances (90%). The average age was 56 years with a sex-ratio (M/F) of 0.94. Most patients had type 2 diabetes (80%) and degenerative complications were noted in 77.1% of cases. The mean BMI was 26 kg/m 2 and 28.6% of the patients were obese. The mean fasting glucose was 11.16 mmol, mean postprandial 14.35 mmol and 85.7% of patients had HbA 1C > 6. The most common urinary symptoms were pollakiuria (60%). The mean USP sub-score was 1.68 for urinary stress incontinence, 8.25 for bladder overactivity and 1.31 for dysuria An impaired quality of life was observed in patients who had urinary disturbances with a mean Ditrovie score of 2.3. The USP sub-score of bladder overactivity was positively correlated with age ( P = 0.01, r = 0.4) and the Ditrovie score was positively correlated with fasting blood sugar ( P = 0.001, r = 0.5). Only 6 patients were followed in physical medicine and rehabilitation. All of them had an obstructive syndrome and an urodynamic assessment was performed in one patient. Despite the impact of urinary disturbances on diabetic patients’ life quality, they are still little known among diabetologists. Their clinical diversity requires urodynamic study. Multidisciplinary work would be required, especially on this subject in collaboration with diabetologists.

Clinical Profile and Risk Factors of Urinary Tract Infection Among Pregnant Women During First Trimester

Background : Risk factors of Pregnancy is a stress that may reveal a variety of medical conditions which includes hypertension, metabolic syndrome, pre-eclampsia, gestational diabetes and ischemic heart disease etc. Urinary tract infection in first trimester is not uncommon with different risk factors. So the objective of the present study was to describe the clinical profile and risk factors of urinary tract infections during 1st trimester of pregnancy. Materials and methods: A descriptive study was conducted in the Obstetric and Gynaecology Department of BGC Trust Medical College Hospital, Chittagong from 1st January to 30th August 2016. Total 100 women were selected to ascertain the frequency and pattern of urinary symptoms as well as the risk factors of Urinary Tract Infection (UTI) such as age, parity, past history of UTI and haemoglobin among women attending an antenatal clinic. All pregnant women at 1st trimester irrespective of age, parity and gestational age were included, while women with known underlying renal pathology, chronic renal disease, renal transplant, diabetes or taking immunosuppressant therapy were excluded. Informed consent was taken and data collected on a self designed proforma. All the women underwent complete examination of urine. Dipstick test was performed on midstream urine and urine was cultured incase of positive dipstick test and women with urinary symptoms. Data was analyzed on SPSS version 18. Results: Regarding age distribution of the patients and found more than a half (52.0%) of patients belonged to 20–25 years age group. The mean (±SD) age of the patients was 23.7±4.5 years with range from 16 to 32 years. Regarding the general examination it was observed that anxious was found 55(55.0%), mild anaemia 59(59.0%), fever 25(25.0%) and high respiratory rate 16(16.0%). Build, nutritional status, lungs and examination of breast shows normal of the studied patients. The mean (±SD) Hb% of the patients was 10.0±0.6 gm/dl with range from 9 to 11 gm/dl. The mean (±SD) total count of the patients was 8428.6±1746.9/cumm with range from 6000 to 10000 /cumm. The mean (±SD) differential count of the patients was 69.0±3.4% with range from 65 to 75. The mean (±SD) ESR of the patients was 43.6±5.4 mm in 1st hour with range from 30 to 50 mm and the mean (±SD) RBS was 95.7±8.7 mg/dl with range from 90 to120 mg/dl. Pseudomonas 23(23.0%) Klebsilla 15(15.0%) E. coli 45(45.0%) and Proteus 17(17.0%) isolated from urine of UTI after caesarean section cases. Abnormal voiding pattern 87 (40.3%). Illiteracy(15%) History of sexual activity(10%), Low socioeconomic (Monthly income &lt; Tk. 10,000 / month) group(17%) Past history of UTI(5%) and Multiparity(14%) were found to be risk factors for UTI in 1st trimester in these women. Conclusion: The common urinary symptoms encountered in the studied women were abnormal voiding pattern followed by irritative symptoms. Majority of urinary symptoms were due to pregnancy related changes in the urinary system. Past history of UTI, sexual activity, lower socioeconomic group and multi parity were significant risk factors for UTI.&#x0D; JCMCTA 2017 ; 28 (1) : 21 - 26