Difficult Urination Research Articles

Использование тулиевого лазера в лечении стриктуры уретры.

Introduction. The thulium laser is relatively recently used in the treatment of various urological diseases. Only a few studies report the use of thulium laser urethrotomy for urethral strictures. The purpose of this study was to evaluate the results of the use of a thulium laser for the treatment of urethral strictures. Materials and methods. A prospective, observational, uncontrolled study included 45 men with urethral stricture, aged 43 to 85 years (median, 65 years), who underwent thulium laser urethrotomy. The length of the stricture ranged from 0.5 to 2.5 cm (median 1.2 cm). A laser fiber with a length of 200 μm was used at an energy of 0.5 J and a power of 10 W. The success of the treatment was considered the absence of complaints of difficult urination in combination with a maximum urination rate of more than 15 ml/s and no or insignificant amount of residual urine (less than 50 ml). The dynamics of various parameters after surgery were assessed using the Wilcoxon test. The difference between the indicators was considered significant at p<0.05. Results. Postoperative follow-up time ranged from 3 to 48 months (median 18 months). With these follow-up periods, treatment was successful in 32 (71.1%) patients. A significant improvement in the median of the following indicators for the entire group of patients after surgical treatment com- pared with preoperative data was established: maximum urination rate – from 9.2 to 21.1 ml/s (p=0.024); average urination rate – from 4.5 to 10.3 ml/s (p=0.025); residual urine volume – from 110 to 42 ml from 9.2 to 21.1 ml/s (p=0.014); indicators of the IPSS questionnaire – from 20 to 7 points (p=0.011); quality of life according to the IPSS questionnaire – from 5 to 2 points (p=0.017). There were no intraoperative complications. Of the postoperative complications, only urinary tract infection was noted in 5 (11.1%) patients. Conclusions. Thulium laser urethrotomy is a fairly safe and effective method for the treatment of short urethral strictures, regardless of the nature, etiology and localization of the cicatricial process. A small number of observations and a short period of postoperative observations in the world literature dictate the need to continue such scientific research.

Hippocrate’s Contribution Exploring the Tashrih-Al-Nizam-E-Baul (Anatomy of Urinary System): A Comprehensive Review

Hippocrates' early contributions to the understanding of urinary physiology continue to inform contemporary research and medical practice, emphasizing the enduring relevance of his observations in the history of anatomical studies. Hippocrates significantly contributed to understanding the kidneys and urinary system, including the urethra. Furthermore, he recognized the tubes carrying urine from the kidneys to the bladder and the bladder's role in storing and expelling urine. However, his knowledge of blood vessels and the urethra remains limited. Hippocrates, a key figure in the development of clinical nephrology, outlined four renal diseases, including kidney colic, renal tuberculosis, renal vein thrombosis, bilateral papillary necrosis, and chronic suppurative renal infection. In addition, he also described bladder stones, urinary conditions like painful, difficult urination, incontinence, urinary retention, renal colic, and renal tuberculosis. Treatment for urinary disorders included warm applications, baths, plant-derived diuretics, diet, and incision over the kidneys. Urine symptoms included bubbles on the surface, colorless urine, and sudden increases of blood in urine. The Corpus Hippocraticum, a study of the urinary tract, has significantly contributed to urology, particularly in uroscopy and renal stone formation. The study of the urinary tract provides valuable insights into anatomy, physiology, etiology, and treatment of urological diseases. Hippocrates introduced the concept of high-risk operations, advising specialists to perform them and avoiding untrained healers. He differentiated between upper and lower urinary tract infections, identifying blood clots in urine as kidney discharge and bladder infections as bladder stones. This article highlights the fundamental contributions of Hippocrates to the field of nephrology and to the understanding of renal anatomy and shows how his teachings influenced later medical practices and advances in the understanding of renal function and pathology. This review aims to uncover the significance they hold in the historical literature, showcasing the historical impact of his pioneering work on the Tashrih-al-Nizam-e-Baul (Anatomy of Urinary System).

Real-Life Treatment Outcome of Botulinum Toxin A Injection on Overactive Bladder and Voiding Dysfunction in Patients with Central Nervous System Lesions.

Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with neurological lesions in the central nervous system (CNS). Medical treatment usually cannot adequately relieve NLUTD. This study reported the real-life treatment outcome of botulinum toxin A (BoNT-A) for overactive bladders (OAB) and voiding dysfunction in patients with CNS lesions. We retrospectively analyzed the first-time treatment outcome of 74 patients who received detrusor 100 U BoNT-A for OAB and 45 patients who received a urethral sphincter 100 U BoNT-A injection for voiding dysfunction. The treatment outcome, therapeutic duration, and adverse events (AE) after BoNT-A were compared among different CNS lesions and among patients with different urodynamic characteristics. The study included 74 patients receiving detrusor injections for OAB (36 with cerebrovascular accidents, 13 with Parkinson's disease, and 25 with dementia) and 45 patients receiving a urethral sphincter injection for voiding dysfunction (26 with cerebrovascular accidents, 7 with Parkinson's disease, and 12 with dementia). After detrusor BoNT-A treatment, urinary continence was achieved in 28.4% of patients with neurogenic OAB, postoperative difficult urination in 59.5%, acute urinary retention (AUR) in 9.5%, and urinary tract infection (UTI) in 14.9%, with a therapeutic duration of 6.43 months. There were no differences among subgroups or between patients with detrusor overactivity (DO) and DO with detrusor underactivity (DU) in terms of treatment outcomes and AEs. The improvement rate of urethral sphincter BoNT-A injections was 75.6% without any difference among subgroups. After treatment, 24.4% of the patients had exacerbated urinary incontinence, 33.3% had persistent difficult urination, and 15.6% had UTI. Patients with dementia had higher rates of difficult urination and UTI, higher postvoid residual volume, and a shorter therapeutic duration. Patients with DU and those without urethral sphincter dyssynergia had less favorable outcomes after their urethral sphincter BoNT-A injection. The therapeutic efficacy of detrusor BoNT-A injection for OAB due to CNS lesions is limited, with high rates of difficult urination, AUR, and UTI. Although urethral sphincter BoNT-A injection is effective in treating voiding dysfunction; however, exacerbated urinary incontinence and persistent difficult urination remain a problem, particularly in patients with dementia.

The unbroken chain of female genital mutilation: a qualitative assessment of high school girls’ perspectives

BackgroundFemale Genital Mutilation (FGM) is defined as any procedure that involves damage to the female external genitalia. This practice is majorly prevalent in Sudan, as it is estimated that over 12 million Sudanese women are circumcised. This study uncovers rural females’ knowledge and insights about FGM domestically.MethodsA qualitative, deductive study with thematic analysis was conducted. A total of 42 female high school students were recruited and divided into five focus groups, each of which included girls from four different high school classes in the main school of the study area. A topic guide was prepared and used to lead the focus groups. Thematic analysis was used, and the study data had been categorized into four themes: knowledge, procedure and performance, experience, and practice. The condensed meaning units of each theme were identified, then classified to formulate sub-themes.ResultsAll the participants indicated that FGM is a traditional practice in the village. The vast majority have heard about it from family members, mainly mothers and grandmothers. Regarding the procedure, all the participants agreed that midwives perform FGM, but most of them don’t know what exactly is being removed. According to all participants, mothers and grandmothers are the decision-makers for FGM. The majority of the participants stated that they do not discriminate between the circumcised and uncircumcised women and most of them agreed that circumcision has negative side effects. They have mentioned pain, difficult urination, and walking as early side effects, while psychological impacts and labor obstruction as late ones. Generally, the majority of the participants agreed that circumcision is not beneficial and should stop.ConclusionKnowledge regarding the dangers of FGM among high school girls is better than expected given the high prevalence of the practice. Generally, the process is well understood, the performers are known, the experience is universal, and the side effects are acknowledged. Nevertheless, a majority still showed an intent to circumcise their daughters in the future.

Synergy between human DNA ligase I and topoisomerase 1 unveils new therapeutic strategy for the management of colorectal cancer

DNA topoisomerase 1 (Topo 1) is a pivotal player in various DNA processes, including replication, repair, and transcription. It serves as a target for anticancer drugs like camptothecin and its derivatives (Topotecan and SN-38/Irinotecan). However, the emergence of drug resistance and the associated adverse effects, such as alopecia, anemia, dyspnea, fever, chills, and painful or difficult urination, pose significant challenges in Topo 1-targeted therapy, necessitating urgent attention. Human DNA Ligase 1 (hLig I), recognized primarily for its role in DNA replication and repair of DNA breaks, intriguingly exhibits a DNA relaxation activity akin to Topo 1. This raised the hypothesis that hLig I might compensate for Topo 1 inhibition, contributing to resistance against Topo 1 inhibitors. To explore this hypothesis, we assessed the efficacy of hLig I inhibition alone and in combination with Topo 1 in cancer cells. As anticipated, the overexpression of hLig I was observed after Topo 1 inhibition in colorectal cancer cells, affirming our hypothesis. Previously identified as an inhibitor of hLig I’s DNA relaxation activity, compound 27 (C 27), when combined with Topotecan, demonstrated a synergistic antiproliferative effect on colorectal cancer cells. Notably, cells with downregulated hLig I (via siRNA, inhibitors, or genetic manipulation) exhibited significantly heightened sensitivity to Topotecan. This observation strongly supports the concept that hLig I contribute to resistance against clinically relevant Topo 1 inhibitors in colorectal cancers. In conclusion, our findings offer evidence for the synergistic impact of combining hLig I inhibitors with Topotecan in the treatment of colorectal cancers, providing a promising strategy to overcome resistance to Topo 1 inhibitors. Communicated by Ramaswamy H. Sarma

Efficacy of Low-Frequency Electroacupuncture on Urinary Retention After Spinal Anesthesia

PurposeThis study was designed to evaluate the efficacy of low-frequency electroacupuncture (EA) in the prevention of urinary retention after orthopedic surgery. DesignA double-blind placebo-controlled clinical trial. MethodsEighty patients with spinal anesthesia were randomly allocated into the groups of EA (40 cases) and control (40 cases). In the first group, the EA was applied to four points of SP6, SP9, ST28, and CV2; 4 Hz, retaining for 20 minutes in the postanesthesia care unit (PACU). In the control group, no intervention was applied. The incidence of postoperative urinary retention, incomplete or difficult urination, and the first automatic micturition time since spinal anesthesia were compared between the two groups. FindingsThe incidence of urinary retention and incomplete urination in the EA group was significantly lower than that in the control group; the time to first urination was shorter in the intervention group than in the control group (P < .05). ConclusionsElectroacupuncture after spinal anesthesia improves bladder function and reduces the need for a urinary catheter and its possible complications.

Clinical application of Chaihu Jia Longgu Muli Decoction based on modern pathophysiology mechanism

Chaihu Jia Longgu Muli Decoction was firstly recorded in Treatise on Cold Damage(ZHANG Zhong-jing, Eastern Han dynasty). According to this medical classic, it is originally used in the treatment of the Shaoyang and Yangming syndrome. Based on the modern pathophysiological mechanism, this study interpreted the classic provisions of Chaihu Jia Longgu Muli Decoction. Original records of &quot;chest fullness&quot; &quot;annoyance&quot; &quot;shock&quot; &quot;difficult urination&quot; &quot;delirium&quot; &quot;heavy body and failing to turn over&quot; all have profound pathophysiological basis, involving disorders in cardiovascular, respiratory, nervous, and mental systems. This formula is widely used, which can be applied to treat epilepsy, cerebral arteriosclerosis, cerebral infarction, and other cerebrovascular diseases, hypertension, arrhythmia, and other cardiovascular diseases, insomnia, constipation, anxiety, depression, cardiac neurosis and other acute and chronic diseases as well as diseases in psychosomatic medicine. The clinical indications include Bupleuri Radix-targeted syndrome such as fullness and discomfort in chest and hypochondrium, bitter taste mouth, dry throat, and dizziness, the insomnia, anxiety, depression, susceptibility to fright, upset, dreamfulness and other psychiatric symptoms, red tongue, thick and yellow tongue coating, and wiry hard and powerful pulse. This formula was found to be used in combination with other formulas, such as Gualou Xiebai Decoction, Wendan Decoction, Zhizhu Pills, Juzhijiang Decoction, Suanzaoren Decoction, and Banxia Baizhu Tianma Decoction.

Zhenwu Decoction:connotation interpretation based on severe cases and modern pathophysiological mechanisms and application in treatment of heart failure in critical care unit

Zhenwu Decoction is recorded in Treatise on Febrile Diseases by an outstanding physician ZHANG Zhong-jing in the Han dynasty. With effect of warming yang, transforming Qi, and promoting urination, Zhenwu Decoction is mainly used to treat edema due to yang deficiency. The studies of the severe and critical cases and the pathophysiological mechanisms have demonstrated that the record of Zhenwu Decoction in Treatise on Febrile Diseases describes the clinical symptoms and therapeutic regimen of acute heart failure. The syndrome treated by this formula may be related to the misdiagnosis and wrong treatment. Due to the difficult distinguishing between cardiogenic dyspnea and pulmonary dyspnea, high doses of Ephedrae Herba may be misused for inducing sweating, which may finally lead to the acute aggravation of heart failure, electrolyte disorder, and pulmonary infection. The syndrome treated by Zhenwu Decoction can illustrate the lack of experience of ancient physicians in treating acute heart failure. The description of &quot;trembling and shivering&quot; may be the clinical manifestation of heart failure, which is an upgraded version of &quot;trembling and shaking&quot; treated by Linggui Zhugan Decoction.(1)In terms of diseases, Zhenwu Decoction is suitable for the treatment of acute or chronic heart failure, cardiorenal syndrome, and diuretic resistance. The decoction is especially suitable for treating whole heart failure, acute heart failure, heart failure with reduced ejection fraction, and heart failure with the syndrome of sold and dampness. In addition, it can be used to treat both type Ⅱ and type Ⅳ cardiorenal syndrome.(2)In terms of symptoms, Zhenwu Decoction can be used for treating chest tightness, palpitations, lower limb edema, difficult urination or increased urine output, fear of cold, pale fat tongue with teeth marks, white and slippery tongue fur, and deep or slow pulse.(3)In terms of the pharmacological mechanism, Zhenwu Decoction treats heart failure following the principle of promoting urination, expanding blood vessels, and invigorating heart in modern medicine. Aconiti Lateralis Radix Praparata is the sovereign herb in the formula, with the recommended dosage of 30-60 g. However, arrhythmia may be caused by high doses of Aconiti Lateralis Radix Praparata, which should be used with concern. In addition to Zhenwu Decoction, Shenqi Pills, Renshen Decoction, Wuling Powder, and Fangji Huangqi Decoction with the effect of invigorating spleen, replenishing Qi, warming Yang, and promoting urination can be used in the recovery stage. The therapy of reinforcing Yang was the last choice for critical cases due to the lack of medical conditions, unclear clinical diagnosis in history, which should be treated objectively now.

THE SAFETY PROFILE AND EFFICIENCY OF THYROIDECTOMY UNDER LOCAL ANAESTHESIA

Introduction: Thyroidectomy is done in many indications ranging from thyroid cancers to nodular types of the thyroid. There are several types of thyroidectomy in which complete removal is done or segmental removal is also preferred. Removal of thyroid tissue is done both in benign and malignant diseases of the thyroid. Thyroid surgery was conducted utilising local anaesthetic procedures in the early twentieth century. As general anaesthesia became safer, doctors began to perform thyroidectomy under general anaesthetic exclusively. Recent accounts of thyroidectomy under local anaesthesia, on the other hand, state that the results are comparable to thyroidectomy under general anaesthetic.&#x0D; Hypothesis: It is hypothesised that thyroidectomy can be effectively performed by applying local anaesthesia with Monitored Anaesthesia Care. The similar or better outcome can be obtained as compared to general anaesthesia.&#x0D; Materials and Methods: The present study is a retrospective study that was conducted during the period of eight Months. Applying inclusion and exclusion criteria, 110 patients were considered for this study. These 110 patients were scheduled for thyroidectomy. The study classified the patients according to the type of anaesthesia they received. Group 1 patients are those who were given general anaesthesia while group 2 patients were given local anaesthesia with MAC. The main outcomes were assessed by several factors and specially shifting of choice of anaesthesia (local or general).&#x0D; Setting: The university affiliated hospital with more than 700 beds.&#x0D; Results: Significant findings were obtained in number of patients were admitted to PACU, number of patients with PONV, time spent in PACU, difficult urination, etc. These findings have shown that shifting trend to local anaesthesia with MAC after the study.Hence there is a shift of choice towards local anaesthesia with MAC. Half of the patients are later anaesthesized by local anaesthesia (P&lt;0.005).&#x0D; Conclusion: The study concludes that the local anaesthesia with MAC is effective and safe to be used in thyroidectomy and can replace general anaesthesia.&#x0D; Keywords: thyroidectomy, thyroid gland, local anaesthesia, general anaesthesia

Total pelvic organ prolapses and its surgery with meses: Adventure or cure?

Total pelvic organ prolapse is a condition that is frequently seen in elderly women and presents with defecation and urinary system dysfunctions and impairs quality of life. Study objective: While preparing this study with its results, our aim was to evaluate the positive effect of minimally invasive repair with mesh on impaired organ functions, anatomy and quality of life in patients with obvious pelvic organ prolapse. Design: Among the people who applied to the gynecology and proctology outpatient clinic within a certain time period, the files of the patients with complaints stated below were scanned. The determined parameters were collected and evaluated prospectively. Statistical study was done with SPSS 15.0. Patients: The patients were those who applied to the gynecology and proctology outpatient clinic. Patients with complaints of vaginal/pelvic fullness, constipation, fecal incontinence, and prominent vaginal tissue prolapse between the legs were selected to participate in the study. Measurement and main results: Laparoscopic promontofixation was performed on 8 patients with overt pelvic organ prolapse (POP-Q III and IV), among those who applied to the outpatient clinic with complaints of pelvic fullness, pain, difficult urinating, constipation or overt organ prolapse between 2015-19. Pelvic dysfunction, difficult urination and defecation function of these patients were evaluated. Pelvic organ distress, urinary distress, and colorectal distress inventory questionnaires were administered to the patients before and during follow-up and the measurements were compared. Complications related to surgery and recurrence was also monitored during follow-up. In those patients followed for an average of 29.5 months. Surgical recurrence was observed in one patient and various surgical complications were observed in 4/8 patients. At the end of the comparative evaluation of the questionnaires, it was determined that the patients' pelvic function and difficult urination improved with surgery. However, an improvement could not be demonstrated in defecation function. Conclusion: Laparoscopic promontofixation should be kept in mind as a surgical method that can provide functional improvement in selected patients with overt pelvic organ prolapse.

SUPERFICIAL MYOFIBROBLASTOMA OF THE GENITAL TRACT : A CASE REPORT OF VAGINAL SMFGT

Superficial myofibroblastoma of the lower female genital tract is a rare benign, recently recognized neoplasm that mostly affects the vulvovaginal area. In this paper we reported a case of 47years old lady who had 3-Normal vaginal deliveries , she had presented with complain of dysuria , difficult micturition lower abdominal pain, heaviness in the vagina and vaginal discharges. Vaginal examination showed a well demarcated , smooth mass measuring about 7cm x3cm. Transvaginal ultrasound was performed which showed a well -defined isoechoic solid lesion with heterogenous echo pattern which occupied the upper portion of the anterior vaginal wall. Magnetic resonance imaging showed a lesion described as a well defined mass at the level of anterior vaginal wall measuring 3.1APX4.5TVX3.3CC cm. The mass was removed per vaginal route , histopathologically, the tumor was characterized by nodular stromal spindle cell lesion, well defined and partly encapsulated with myxoid degeneration and prominent vascular network. No necrosis is seen .No significant mitotic activity indentified. The findings were consistent with superficail myofibroblastoma. Immunohistochemistry stain was carried out which was positive for CD34, Desmin , Vimentin and weakly positive for ER.

Comparison of the outcomes of hemorrhoidectomy and PPH in the treatment of grades III and IV hemorrhoids.

To investigate the clinical effect and outcome of traditional hemorrhoidectomy and procedures for prolapse and hemorrhoid (PPH) for the treatment of grades III and IV hemorrhoids.We retrospectively reviewed 1003 grades III and IV hemorrhoid patients who presented to our hospital. A total of 585 patients underwent PPH, and 418 patients underwent hemorrhoidectomy. The outcomes were 1-year recurrence, postoperative complications, surgery-related complications, and indicators.No significant difference between the 2 treatment groups regarding patient demographics. All patients underwent more than 12months of postoperative follow-up. No significant difference between the 2 treatment groups in 1-year recurrence. PPH can markedly improve anal pain, postoperative bleeding, difficult urination, and postoperative resting anal pressure. The operative blood loss, operative time, wound healing time, and wound infection rates were decreased significantly in the PPH group compared with the traditional hemorrhoidectomy group.Our data suggest that PPH is useful and safe for grades III and IV hemorrhoids. It can reduce postoperative and surgery-related complications. However, this was a single-hospital retrospective study. Therefore, well-designed, multicenter, randomized controlled trials are needed to evaluate the value of PPH for grades III and IV hemorrhoids.

Rezum Therapy for Benign Prostatic Hyperplasia: Dubai's Initial Experience.

IntroductionSymptomatic benign prostatic hyperplasia (BPH) is a condition that affects middle-aged men, leading to a decreased quality of life secondary to symptoms of difficult urination, urinary frequency, urgency and nocturia. The treatment modalities of this pathology include pharmacologic and invasive interventions, both of which vary in effectiveness and they come with a myriad of side effects. Recent advancements have allowed for the development of Rezum, a minimally invasive and effective approach to treating BPH while maintaining a good safety profile with comparable outcomes to other treatment modalities.MethodsWe retrospectively identified 49 patients with symptomatic BPH who underwent Rezum therapy in one center in Dubai, the United Arab Emirates between January and December 2020. We assessed several parameters related to their condition including prostate volume, pre-operative and post-operative post-void residual (PVR) and peak urinary flow (Qmax) number of treatments given, trial without catheter and mean date of follow-up. Safety and side effects were also assessed.ResultOur sample included symptomatic men with a mean age of 64 (10) who had a mean follow-up time of three months (IQR 2-5.2), median prostatic volume of 58 cc (IQR 44-82) and a mean of (SD 33.9). The initial Qmax and PVR were 7.3 ml/s (IQR 5.5-10.3) and 80.4 cm3 (IQR 43.4-120.0) respectively, and post-operative Qmax and PVR were 16.3 ml/s (SD 5.7) and 20.7 cm3 (IQR 16.2-28.2). Post-operatively, we observed a significant increase in Qmax of 8.11 ml/s (p=0.001) post-operatively, a mean decrease of 94.32 cm3 (p=0.001) in PVR. The favorable outcome parameters in Qmax and PVR demonstrate the efficacy of this procedure. We have also noted that the change in Qmax and PVR does not vary by initial prostate volume.ConclusionIn this report, we aimed to highlight the benefit, efficacy and safety of offering Rezum to patients with symptomatic BPH in a single center in Dubai, reporting on the first United Arab Emirates experience with this novel procedure. This procedure confers the benefit of being minimally invasive, safe and effective, and with lower rates of sexual dysfunction compared to medical therapy or trans-urethral resection of the prostate (TURP). It is associated with similar outcomes to TURP, and an improvement in quality of life, while carrying a low-risk profile. Our experience corresponds with the available literature regarding the efficacy and satisfaction rates of Rezum for BPH patients. We hope that results from this study encourage further investigation into the long-term implications of Rezum, up to five years post-operatively.

Herb-target virtual screening and network pharmacology for prediction of molecular mechanism of Danggui Beimu Kushen Wan for prostate cancer

Prostate cancer (PCa) is a cancer that occurs in the prostate with high morbidity and mortality. Danggui Beimu Kushen Wan (DBKW) is a classic formula for patients with difficult urination including PCa. This study aimed to investigate the molecular mechanisms of DBKW for PCa. We obtained DBKW compounds from our previous reviews. We identified potential targets for PCa from literature search, currently approved drugs and Open Targets database and filtered them by protein–protein interaction network analysis. We selected 26 targets to predict three cancer-related pathways. A total of 621 compounds were screened via molecular docking using PyRx and AutoDock Vina against 21 targets for PCa, producing 13041 docking results. The binding patterns and positions showed that a relatively small number of tight-binding compounds from DBKW were predicted to interact strongly and selectively with three targets. The top five high-binding-affinity compounds were selected to generate a network, indicating that compounds from all three herbs had high binding affinity against the 21 targets and may have potential biological activities with the targets. DBKW contains multi-targeting agents that could act on more than one pathway of PCa simultaneously. Further studies could focus on validating the computational results via experimental studies.

Phytochemistry, pharmacodynamics, and pharmacokinetics of a classic Chinese herbal formula Danggui Beimu Kushen Wan: A review.

Danggui Beimu Kushen Wan (DBKW) is a classic herbal formula for difficult urination and has been widely used for urinary-related disorders and cancers in current clinical practice. This study aimed to comprehensively review the phytochemistry, pharmacodynamics, and pharmacokinetics of DBKW in experimental studies. We searched 21 databases to identify experimental studies of DBKW. We also searched 11 databases to identify and summarize compounds from DBKW's ingredients. A total of 423 studies of DBKW were identified and 15 studies were included. For Angelicae Sinensis Radix (ASR) and Sophorae Flavescentis Radix (SFR), 2,425 and 2,843 studies were identified, and 42 and 33 studies were included, respectively. Eight compounds were found in the whole formula, 408 compounds from ASR, and 277 compounds from SFR. DBKW may have anticancer effects (inhibiting the growth of tumors, regulating cell proliferation, inducing tumor cell apoptosis, suppressing invasion and metastasis of cancer, enhancing the therapeutic effects of chemotherapy, and relieving toxicity of chemotherapy) and have benefits on chronic prostatitis (reducing inflammation, inhibiting oxidation, regulating sex hormone, and stimulating immune system). The pharmacokinetics of the seven primary compounds from DBKW were also summarized. DBKW contains multiple compounds that may act on more than one pathway of the conditions simultaneously.

Transobturator four-arms mesh in the surgical management of cystocele: a long-term follow-up.

We studied the long-term efficacy and safety of cystocele operation by polypropylene mesh. A total of 198 women with stage ≥2 cystocele who had anterior vaginal wall repair with transobturator four-arm polypropylene mesh during 2003 to 2015 were evaluated. Outcomes including clinical characteristics and complications were reviewed by extracting patient data from electronic medical records. In addition, telephone interviews were conducted using a validated questionnaire along with physical examination. The follow-up period was 9.3±0.3 years. The cystocele stage in patients was significantly decreased post-operation compared to that preoperation. The anatomical cure rate for cystocele was 93.4%, and that for stress urinary incontinence was 95%. Comparing the three questionnaires indicated overall average score was improved significantly, except for Female Sexual Function Index Assessment. Early complications were either resolved spontaneously or controlled medically in four cases of hematoma or abscess, three cases of vaginal infection and urinary tract infection, and four cases of difficult micturition. In late complications, four cases of pain were managed, five cases of recurrence were observed and two cases of mesh exposure were treated with ointment and local excision. Transobturator four-arms mesh is an effective and safe method for cystocele repair with low rate of recurrence and complications. We suggest that the use of transobturator four-arm mesh is a still good choice for the old patients with cystocele who are not suitable for general anesthesia and reside in areas where laparoscopy and robots are not available.

De Castro falloplasty of the with penile agenesis

Introduction. Penile agenesis (aphallia) is an extremely rare congenital disorder. At present, about 100 cases of the anomaly have been described around the world. The incidence of this congenital anomaly is estimated to be one case per 2030 million births. One of the most commonly used reconstructive procedures today is the technique proposed by Roberto De Castro in 2007. In this article, we present a clinical case of aphallia in a boy who underwent phalloplasty.&#x0D; Materials and methods. A newborn boy presented with aphallia, combined with abnormal development of both kidneys. At birth, the child had difficult urination through the fistula at the edge of the anus. The meatotomy and urethral dilation were performed on the fifth day of the infant`s life. On day 28 of the child`s life, surgical intervention was performed to remove the left non-functioning kidney and a right cutaneous ureterostomy because of the recurrence of febrile urinary tract infection. At 13 months, the tissue expander was installed above the pubic bone. At 16 months, the child underwent the De Castro phalloplasty technique while in the supine position.&#x0D; Results. The child was examined 3, 6, and 12 months after the surgical treatment. Phalloplasty has had good outcomes as evaluated by parents and surgeons. At present, the boy is under the supervision of urologists, who plan to perform further surgical treatment of the urinary system.&#x0D; Conclusion. Phalloplasty, in the case presented, had a good cosmetic result. In our opinion, it proved to be the correct initial stage of treatment for aphallia, an extremely rare genital malformation.

Frontiers in the Clinical Applications of Botulinum Toxin A as Treatment for Neurogenic Lower Urinary Tract Dysfunction.

Patients with neurogenic lower urinary tract dysfunction (NLUTD) experience urinary incontinence with or without difficult urination, which might promote recurrent urinary tract infection (UTI) and exacerbate upper urinary tract function. Nonetheless, appropriate bladder management has been shown to reduce urological complications and improve quality of life. In addition to pharmacological therapy and surgical intervention, botulinum toxin A (BoNT-A) has been widely utilized in NLUTD. The therapeutic efficacy of detrusor BoNT-A injections for neurogenic detrusor overactivity due to spinal cord injury (SCI), multiple sclerosis, or other central nervous system lesions, such as cerebrovascular accident, Parkinson disease, early dementia, and pediatric NLUTD due to myelomeningocele, has been well established, with repeated BoNT-A injections every 6 to 9 months being necessary to maintain its therapeutic effects. Urethral BoNT-A injection can decrease urethral sphincter resistance and facilitate efficient voiding in patients with NLUTD who wish to preserve self-voiding. Detrusor BoNT-A injection can also decrease the occurrence of autonomic dysreflexia in patients with SCI, even after failed augmentation enterocystoplasty, with additional benefits including reduced UTI episodes and preserved renal function with repeated injections. However, this treatment does have some side effects. Complete informed consent for BoNT-A injection therapy with full disclosure of its potential complications should therefore be obtained before this procedure is undertaken.

Transurethral Resection of Bladder Neck in the Management of Primary Bladder Neck Obstruction in Female: Our Preliminary Experience in Bangladesh

Objectives: To determine the effectiveness of transurethral resection of bladder neck in the management of primary bladder neck obstruction (PBNO) in female Patients and Methods: This prospective study has been done with thirty female patients aged from 27 to 48 years who were presented with difficult micturition or urinary retention. These patients had unremarkable physical findings with normal perianal sensation, anal sphincter tone and lower extremity reflexes. Patients associated with cystocele, meatal stenosis, stricture urethra, urethral caruncle and urethral diverticula that may lead to mechanical bladder outflow obstruction were excluded from the study. Preoperative investigations include uroflowmetry, ultrasonography, serum creatinine, urethrocystoscopy with simultaneous “water flow test” was done. Seven patients presented with obstructed voiding symptom without renal impairment (serum creatinine, mean±SEM 1.24±0.04) and were initially treated with á-blocker (category A). Among the other 23 patients those had renal impairment 18 presented with near retention and these patients were on indwelling catheterization before operation (category B, serum creatinine, mean±SEM 2.72±0.13).Rest of the 5 patients presented with nausea, vomiting, and disorientation in addition to near retention and were put on haemodialysis along with indwelling catheterization to reach near normal creatinine level before operation(category C, serum creatinine, mean±SEM,9.34±0.96 ). PBNO causing voiding difficulty were diagnosed in all the cases and were undergone transurethral bladder neck resection (BNR). Three months after operations, their pre- and post-operative symptoms were analyzed, and serum creatinine levels, ultrasonographic findings (MCC, PVR), uroflowmetric study were compared. Results: Twenty-nine (96.33%) Patients become symptom free. Their average pre- and post-operative values of MCC (Maximum Cystometric Capacity), PVR (Post Voidal Residual urine), Qmax (Peak urinary flow during uroflowmetric study, Serum creatinine level were changed from 679.50 to 482.17ml, from 574.50 to 29.37ml, from 8.43 to 29.37ml/sec, from 3.48 to 1.13 mg/dl respectively. One patient (3.33%) did not continent ever postoperatively. One patient had become dry after using pad for stress incontinent for one month only. Serum creatinine level of category C patient did not reach to the normal level (post operative creatinine level Mean±SEM,2.8±0.15)within this three moths follow up period. Conclusions: Our short term follow-up suggests that judicious Transurethral BNR is effective in relieving voiding difficulty due to primary bladder neck obstruction in female. A thorough gynaecological, neurological and urological examination is essential along with uroflowmetric, ultrasonographic and cystoscopic study to reach a correct diagnosis and making a treatment plan. Bangladesh Journal of Urology, Vol. 17, No. 1, Jan 2014 p.23-28

A case of incomplete separation of the hymen

Maria R.R. (Medical. Zhurn., No. 593), a peasant woman of the Novgorod province, married, 27 years old, was admitted to the Hospital Obstetric and Gynecological Clinic of prof. K. Ѳ. Slavyansky on September 10, 1891, about complaints of pain in the lower abdomen, difficult and painful urination, lack of blood for two months, constipation and loss of sleep.