Urinary Research Articles

Nationwide database study of postoperative sequelae and in-hospital mortality in super-elderly hip fracture patients

Abstract Introduction The risk of postoperative sequelae and in-hospital mortality in Japanese patients aged 90 years and older with hip fractures is unexplored. This study aims to use a comprehensive medical claims database in Japan to compare super-elderly patients aged 90 years and older with elderly aged 65–89 and clarify the risk of sequelae and in-hospital mortality in super-elderly patients. Materials and methods We retrospectively analyzed the Diagnosis Procedure Combination (DPC) database for all of Japan from April 2016 to March 2022. Medical records from approximately 1100 DPC-related hospitals were provided with consistent consent during this period. In this study, we focused on super-elderly patients and examined the association with the risk of postoperative pneumonia, pulmonary embolism, myocardial infarction, urinary tract infection, acute renal dysfunction, subsequent cognitive dysfunction, and in-hospital mortality after one-to-one propensity score matching. Results After performing propensity score matching based on sex and comorbidities, 129,953 pairs of patients were identified. These pairs were compared to elderly and super-elderly patients. The results of this study showed that compared with hip fractures in the elderly, hip fractures in the super-elderly were associated with an increased risk of pneumonia, urinary tract infection, acute renal dysfunction, subsequent cognitive dysfunction, and in-hospital mortality after adjustment for confounders. The odds ratio of in-hospital mortality was 2.190 (95% CI 2.062–2.325). Conclusion As it has been shown that super-elderly patients with hip fractures are at greater risk of respiratory and urinary tract infections and increased in-hospital mortality, careful attention should be required for perioperative management.

Klebsiella pneumoniae Complex-Associated Peritonitis, Lymphadenitis, and Pyelonephritis in Juvenile Raccoons (Procyon lotor) under Rehabilitator Care in New York, New Jersey, and Wisconsin, USA.

Klebsiella spp. are gram-negative facultative anaerobic heavily encapsulated bacteria associated with opportunistic and primary infections in a wide range of species. We assessed a series of cases (n=8) of necrosuppurative peritonitis, lymphadenitis, and/or pyelonephritis in wild juvenile raccoons (Procyon lotor) that died under rehabilitator care in New York, New Jersey, and Wisconsin, US, between July 2020 and December 2023, plus a retrospective case of a juvenile raccoon necropsied from New York in August 2011. Gross necropsy (n=9) and histopathology (n=9) were performed to characterize the lesions, whereas bacterial culture (n=8) was used to identify and characterize the bacteria and associated phenotype. We observed gram-negative short rods and coccobacilli (7/9; 78%), fibrinosuppurative peritonitis of variable severity (7/9; 78%) correlated to gross pyoabdomen (5/9; 56%) or abscessation (2/9; 22%), lymphadenomegaly and associated necrosuppurative lymphadenitis (5/9; 56%), and urinary tract disease (3/9; 33%). Aerobic culture of affected tissues isolated Klebsiella pneumoniae (n=4), K. pneumoniae subsp. ozaenae (n=2), Klebsiella variicola (n=1), and Klebsiella sp. (n=1). Our study strongly suggests an association of bacteria within the K. pneumoniae complex with peritonitis, lymphadenitis, and pyelonephritis in raccoons. Disease might be associated with underlying nosocomial infection given that all animals were under rehabilitator care at the time of death.

Decreasing the Use of Cefdinir for Pediatric Urinary Tract Infections in a Rural Health Care System: A Quasi-experimental Study.

There are several antimicrobial options for treating urinary tract infection in children. Although cefdinir is commonly used, better options exist. We developed an intervention bundle to reduce the use of cefdinir in favor of cephalexin. The intervention bundle decreased cefdinir use by 19.1% while use of cephalexin increased by 19.8%.

Observation of neutrophil extracellular traps in the development of diabetic nephropathy using diabetic murine models.

Diabetic nephropathy (DN) is a progressive complication among patients with diabetes and the most common cause of end-stage kidney disease. Neutrophil extracellular traps (NETs) are known to play a role in kidney disease, thus this study aimed to determine their role in the development of diabetic kidney disease using diabetic murine models. Protein and histological analyses revealed that db/db mice and streptozotocin DN models expressed no significant NET-related proteins, myeloperoxidase, citrullinated histone H3 (citH3), neutrophil elastase, and lymphocyte antigen 6 complex locus G6D (Ly6G). However, the inflamed individuals in the DN model showed that citH3 and Ly6G were highly deposited in the renal system based on immunohistochemistry images. In vitro, NET treatment did not induce apoptosis in glomerular endothelial and renal tubular epithelial cells. NET inhibition by DNase administration demonstrated no significant changes in cell apoptosis. NET-related proteins were only expressed in the DN model with tubulointerstitial inflammation. Our study revealed that NETs are only induced in mice with hyperglycemia-induced inflammation.

Advances in sarcopenia and urologic disorders

Sarcopenia is a loss of muscle strength, muscle mass, and function that can increase a patient’s risk of injury, illness, and can even severely impair quality of life and increase a patient’s risk of death. A growing body of research suggests that sarcopenia and urinary tract disorders are closely related. In this review, we aimed to emphasize the definition of skeletal sarcopenia, summarize the methods used to diagnose skeletal sarcopenia, discuss the advances in the study of sarcopenia in benign diseases of the urinary system, discuss the advances in the study of sarcopenia in malignant diseases of the urinary system. Sarcopenia and urologic diseases interact with each other; urologic diseases cause sarcopenia, and sarcopenia aggravates the condition of the original disease, thus falling into a vicious circle. This review provides a comprehensive understanding of sarcopenia in urologic diseases, which is very important for the management and prognosis of urologic diseases.

First report on the physicochemical and proteomic characterization of Proteus mirabilis outer membrane vesicles under urine-mimicking growth conditions: comparative analysis with Escherichia coli

IntroductionUropathogenic bacteria employ multiple strategies to colonize the urinary tract, including biofilm formation, invasion of urothelial cells, and the production of adhesins, toxins, and siderophores. Among the most prevalent pathogens causing urinary tract infections (UTIs) are Uropathogenic Escherichia coli and Proteus mirabilis. A notable feature of Gram-negative bacteria is their ability to produce outer membrane vesicles (OMVs), which play critical roles in bacterial survival, virulence, and host-pathogen interactions, including UTIs.MethodsIn this study, OMVs were isolated and characterized from two clinical strains, E. coli U144 and P. mirabilis 2,921, cultured in both Luria-Bertani broth and artificial urine.Result and discussionThe OMVs ranged in size from 85 to 260 nm, with the largest vesicles observed in artificial urine. Proteomic analysis allowed the identification of 282 proteins in OMVs from E. coli and 353 proteins from P. mirabilis when cultured LB medium, while 215 were identified from E. coli and 103 from P. mirabilis when cultured in artificial urine. The majority of these proteins originated from the bacterial envelope, while others were linked to motility and adhesion. Notably, the protein composition of OMVs varied depending on the growth medium, and proteins associated with zinc and iron uptake being more prominent in artificial urine, suggesting their importance in the urinary environment. Crucially, this is the first report to characterize P. mirabilis OMVs under different culture conditions, offering novel insights into the role of OMVs in UTI pathogenesis. These findings provide a deeper understanding of the molecular mechanisms by which OMVs contribute to bacterial virulence, establishing the foundation for potential therapeutic interventions targeting OMV-mediated processes in UTIs.

Towards Understanding the Role of the Glycosylation of Proteins Present in Extracellular Vesicles in Urinary Tract Diseases: Contributions to Cancer and Beyond

Extracellular vesicles (EVs) are a population of nanoscale particles surrounded by a phospholipid bilayer, enabling intercellular transfer of bioactive molecules. Once released from the parental cell, EVs can be found in most biological fluids in the human body and can be isolated from them. For this reason, EVs have significant diagnostic potential and can serve as an excellent source of circulating disease biomarkers. Protein glycosylation plays a key role in many biological processes, and aberrant glycosylation is a hallmark of various diseases. EVs have been shown to carry multiple glycoproteins, but little is known about the specific biological roles of these glycoproteins in the context of EVs. Moreover, specific changes in EV glycosylation have been described for several diseases, including cancers and metabolic, cardiovascular, neurological or kidney diseases. Urine is the richest source of EVs, providing almost unlimited (in terms of volume) opportunities for non-invasive EV isolation. Recent studies have also revealed a pathological link between urinary EV glycosylation and urological cancers, as well as other pathologies of the urinary tract. In this review, we discuss recent research advances in this field and the diagnostic/prognostic potential of urinary EV glycosylation. In addition, we summarize common methods for isolating EVs from urine and techniques used to study their glycosylation.

Clinical application of chromosome microarray analysis and karyotyping in prenatal diagnosis in Northwest China

IntroductionKaryotyping and chromosome microarray analysis (CMA) are the two main prenatal diagnostic techniques currently used for genetic testing. We aimed to evaluate the value of chromosomal karyotyping and CMA for different prenatal indications.MethodsA total of 2084 amniocentesis samples from pregnant women who underwent prenatal diagnosis from 16 to 22 + 6 weeks of gestation between January 2021 and December 2022 were retrospectively collected. The pregnant women were classified according to different prenatal diagnostic indications and underwent CMA and karyotype analysis. Clinical data were collected, and the results of the CMA and karyotype analysis were statistically analyzed to compare the effects of the two diagnostic techniques.ResultsThe total detection rate of abnormal chromosomes was significantly higher using CMA than karyotype analysis. The detection rate of abnormal chromosomes using CMA was significantly higher than that using karyotyping for ultrasound abnormalities, high-risk serologic screening, adverse pregnancy history, positive noninvasive prenatal test (NIPT) screening, and ultrasound abnormalities combined with adverse pregnancy history indications. Among the fetuses with inconsistent results between the two testing methods, 144 had an abnormal CMA but a normal karyotype, with the highest percentage of pregnant women with ultrasound abnormalities at 38.89% (56/144). CMA had the highest detection rate for structural abnormalities combined with soft-index abnormalities among all ultrasound abnormalities. The highest detection rate of copy number variants in the group of structural abnormalities in a single system was in the genitourinary system (3/29, 10.34%).ConclusionCMA can improve the detection rate of chromosomal abnormalities in patients with ultrasound abnormalities, high-risk serologic screening, adverse maternal history, positive NIPT screening, and ultrasound abnormalities combined with adverse maternal history and can increase the detection rate of chromosomal abnormalities in karyotypic normality by 6.91% (144/2,084), this result is higher than similar studies. However, karyotype analysis remains advantageous over CMA regarding balanced chromosomal rearrangement and detection of low-level chimeras, and the combination of the two methods is more helpful in improving the detection rate of prenatal chromosomal abnormalities.

A new nomogram for predicting extraurothelial recurrence in patients with upper urinary tract urothelial carcinoma following radical nephroureterectomy

PurposeWe sought to develop and validate a nomogram for predicting extra-urinary recurrence (EUR) following radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UTUC).MethodsData from 556 UTUC patients post-RNU at the First Hospital of Jilin University were retrospectively analyzed. These patients were categorized into a training group (n=389) and a validation group (n=167). Variables significantly associated with prognosis were identified using univariate Cox regression and most minor absolute shrinkage and selection operator (LASSO) analysis. These independent predictors were incorporated into the nomogram to estimate extra-urinary recurrence-free survival (EURFS). Validation of the nomogram involved ROC curves, calibration plots, and decision curve analysis (DCA). Patients were stratified into two risk categories based on their nomogram scores to compare EURFS using the Kaplan-Meier method.ResultsEight predictors were identified: T-stage, N-stage, tumor grade, local and nerve invasion, preoperative hemoglobin level, neutrophil-to-lymphocyte ratio (NLR), and creatinine, all proving to be independent predictors of EUR. A nomogram was created based on these eight factors, and using the ROC, calibration curves, and DCA, good prediction results were shown in both the training and validation groups. The training and validation groups also showed reliable predictive performance. In particular, there was a significant difference in survival between the high-risk and low-risk groups (P<0.0001). We have also built a network calculator that calculates patient survival time. The URL is https://haowu24.shinyapps.io/dynnomapp.ConclusionA nomogram for predicting distant metastases in UTUC patients was successfully developed, and its accuracy, reliability, and clinical value were demonstrated. This new tool helps to improve the clinical management of UTUC cases.

Identifying and Predicting Risk for Hospital Admission among Patients with Parkinsonism.

Patients with parkinsonism are more likely than age-matched controls to be admitted to hospital. It may be possible to reduce the cost and negative impact by identifying patients at highest risk and intervening to reduce hospital-related costs. Predictive models have been developed in nonparkinsonism populations. The aims were to (1) describe the reasons for admission, (2) describe the rates of hospital admission/emergency department attendance over time, and (3) use routine data to risk stratify unplanned hospital attendance in people with parkinsonism. This retrospective cohort study used Clinical Practice Research Datalink GOLD, a large UK primary care database, linked to hospital admission and emergency department attendance data. The primary diagnoses for nonelective admissions were categorized, and the frequencies were compared between parkinsonism cases and matched controls. Multilevel logistic and negative binomial regression models were used to estimate the risk of any and multiple admissions, respectively, for patients with parkinsonism. There were 9189 patients with parkinsonism and 45,390 controls. The odds of emergency admission more than doubled from 2010 to 2019 (odds ratio [OR] 2.33; 95% confidence interval [CI] 1.96, 2.76; P-value for trend <0.001). Pneumonia was the most common reason for admission among cases, followed by urinary tract infection. Increasing age, multimorbidity, parkinsonism duration, deprivation, and care home residence increased the odds of admission. Rural location was associated with reduced OR for admission (OR 0.79; 95% CI 0.70, 0.89). Our risk stratification tool may enable empirical targeting of interventions to reduce admission risk for parkinsonism patients.

Clinical characteristics of primary vesicoureteral reflux in children with an allergic constitution.

This study was designed to compare the clinical data of vesicoureteral reflux (VUR) in children with and without an allergic constitution. The clinical data of patients hospitalized with VUR due to a urinary tract infection (UTI) between September 1, 2019, and December 31, 2020, were retrospectively analyzed. The patients were divided into two groups: an anallergic constitution group (AC group) and a non-allergic constitution (NAC group), and their UTIs and VUR were compared at baseline and during the follow-up period. (1) Between September 1, 2019, and December 31, 2020, a total of 284 children were hospitalized at Shengjing Hospital Affiliated to China Medical University due to a UTI. These children included 37 cases with primary VUR and 247 cases without VUR (including 59 cases of non-VUR urinary malformation). The proportion of children with an allergic constitution was significantly higher in the patients with VUR than it was in those without VUR or with other urinary malformations (72.97% vs. 48.18% vs. 50.85%, P = 0.005, 0.032). (2) At baseline, the levels of immunoglobulin and immunoglobulin E in the AC group were significantly higher than those in the NAC group (P = 0.042, 0.017). (3) During the follow-up period, the number of recurrent UTI cases in the AC group was significantly higher than that in the NAC group (0.70 ± 0.91 vs. 0.10 ± 0.32, P= 0.005). The difference between the two groups in the VUR remission rate was not statistically significant (40% vs. 50%, P = 0.563). (4) During the follow-up period, the differences in the remission rates of recurrent UTIs and VUR in the two groups were not statistically significant. The incidence of having an allergic constitution is high in patients with VUR, and patients with an allergic constitution present with a higher frequency of recurrent UTIs.

A case report of severe drug-induced immune hemolytic anemia caused by piperacillin

Piperacillin is a beta-lactamase inhibitor frequently used in the treatment of urinary tract infections. It is a broad-spectrum antibiotic with strong antibacterial action against Pseudomonas aeruginosa and Enterobacter, especially extended-spectrum beta-lactamase-producing Enterobacteria and Enterococcus. Side effects of piperacillin include allergic reactions, rashes such as urticaria, leukopenia, interstitial nephritis, asthma attacks, serological reactions, candida infection, and bleeding with more severe reactions resulting in anaphylactic shock. Anemia and hemolytic anemia are rare adverse reactions to piperacillin, with an incidence of 0.01–0.10%. We report herein the case of a severe postoperative immune hemolytic reaction to piperacillin. Fortunately, we quickly recognized and identified the drug reaction caused by piperacillin, immediately stopped the use of piperacillin, and performed a blood transfusion. The patient recovered and was subsequently discharged from the hospital.

Predictive factors of immediate continence after conventional robot-assisted radical prostatectomy: a single-institution retrospective study.

To assess the predictive factors of immediate urinary continence after robot-assisted radical prostatectomy. This study included 282 patients who underwent conventional robot-assisted radical prostatectomy at our institution from April 2019 to March 2024. The primary outcome was immediate urinary continence, defined as the absence of urine leakage immediately after urinary catheter removal on postoperative day 6 or 7. In addition, the immediate urine loss rate, defined as the 24-h urine loss volume divided by the total urine volume after catheter removal, was calculated. The multivariable logistic model was used to assess the possible predictive factors of immediate continence (urine loss rate of 0%). The factors included age, body mass index, Charlson Comorbidity Index, pre-existing lower urinary tract symptoms, presence of an inguinal hernia, prostate volume, membranous urethral length, stratified cancer risk, surgeon's experience, and nerve-sparing procedure. In addition, a multiple linear regression model was established to investigate the associations of the same predictors with immediate urine loss rate (%). We also presented our techniques to achieve immediate continence. The patients' median age was 70 (interquartile range: 63.0-73.0) years. Approximately 39% (n = 111) of patients presented with immediate continence. Age, inguinal hernia, membranous urethral length, and low risk for prostate cancer were associated with immediate continence. These were also statistically significant predictors of immediate urine loss rate. Our study identified factors predicting immediate urinary continence after conventional robot-assisted radical prostatectomy. This information is potentially valuable for preoperative counseling in patients undergoing robot-assisted radical prostatectomy.

The respiratory chain of Klebsiella aerogenes in urine-like conditions: critical roles of NDH-2 and bd-terminal oxidases

Klebsiella aerogenes is an opportunistic nosocomial bacterial pathogen that commonly causes urinary tract infections. Over the past decades, K. aerogenes strains have acquired resistance to common antibiotics that has led to the rise of multidrug-resistant and even pandrug-resistant strains. Infections produced by these strains are nearly impossible to treat, which makes K. aerogenes a global priority to develop new antibiotics and there is an urgent need to identify targets to treat infections against this pathogen. However, very little is known about the metabolism and metabolic adaptations of this bacterium in infection sites. In this work, we investigated the respiratory metabolism of K. aerogenes in conditions that resemble human urine, allowing us to identify novel targets for antibiotic development. Here we describe that, unlike other gram-negative pathogens, K. aerogenes utilizes the type-2 NADH dehydrogenase (NDH-2) as the main entry point for electrons in the respiratory chain in all growth conditions evaluated. Additionally, in urine-like media, the aerobic metabolism as a whole is upregulated, with significant increases in succinate and lactate dehydrogenase activity. Moreover, our data show that the bd-I type oxidoreductases are the main terminal oxidases of this microorganism. Our findings support an initial identification of NDH-2 and bd-I oxidase as attractive targets for the development of new drugs against K. aerogenes as they are not found in human hosts.

Multidrug-Resistant Urinary Tract Infections in Pregnant Patients and Their Association with Adverse Pregnancy Outcomes—A Retrospective Study

Background/Objectives: Multidrug-resistant urinary tract infections (MDR UTIs) constitute an important public health problem, especially in pregnant patients. The aim of this retrospective study was to characterize the bacterial spectrum and the profile of microbial resistance in cases of UTIs occurring in pregnant women, as well as their impact on obstetrical and neonatal outcomes. Methods: A total of 371 pregnant patients with UTIs were included in the analysis and were segregated into the following groups based on the type of bacterial resistance to antibiotics: MDR UTIs (70 patients, group 1), UTIs resistant to one class of antibiotics (108 patients, group 2), UTIs resistant to two classes of antibiotics (102 patients, group 3), and sensitive UTIs (91 patients, group 4). We used descriptive statistics for characterizing and comparing the microbial spectrum and the clinical characteristics of the patients. A multinomial logistic regression model for evaluating the relationship between the type of urinary tract infection and adverse obstetric or neonatal outcomes was employed. Results: In the case of MDR UTIs, the bacterial spectrum mainly included Escherichia coli, Enterococcus faecalis, and Klebsiella species. We found almost universal resistance to ampicillin. Our data confirmed an increased risk of preterm birth, premature rupture of membranes, neonatal respiratory distress syndrome, and neonatal intensive care unit admission for patients with MDR infections. Conclusions: The increased incidence of pathogens resistant to commonly used antibiotic classes in pregnancy suggests the need for the development of local and national protocols that adapt therapeutic and prophylactic regimens to clinical realities.

Acute Ischemic Stroke and STEMI in A 78-Year-Old Female: A Case Report of Dual Life-Threatening Events and Complicated Recovery

Ischemic stroke and ST-elevation myocardial infarction (STEMI) occurring at the same time, are very rare conditions that cause major difficulties in management and present high mortality rates. This manuscript brings into focus a 78-year-old woman who had known diabetes mellitus (DM), hypertension (HTN), dyslipidemia, and ischemic strokes in the past, who presented with focal neurological deficits in the form of sudden onset slurring of speech and facial asymmetry which on investigation revealed a large left middle cerebral artery (MCA) infarction. Few hours later she developed STEMI with ECG changes and raised troponin levels. The patient experienced respiratory difficulty for which the patient was intubated. A percutaneous intervention (PCI) was attempted with moderate results. Complications included heart failure, atrial fibrillation (AF), and septic shock due to a urinary tract infection (UTI) that delayed her discharge from the hospital. Nevertheless, the effective treatment and cooperation between cardiologists and neurologists, stabilized her condition. This case shows the challenges of managing dual pathology (stroke and STEMI simultaneously); therefore, early diagnosis and multidisciplinary management offer the best prognosis to realize optimal outcomes.

Test Smart, Treat Smart-using clinician feedback to adapt a catheter-associated urinary tract infection intervention for spinal cord injury.

Catheter-associated urinary tract infection (CAUTI) prevention is a major target for hospital quality metrics because it is linked to increased morbidity, mortality, and health care costs. Health care systems use strict protocols surrounding catheterization and maintenance, which often disregard the clinical needs of special populations (eg, spinal cord injury [SCI]). However, for populations that rely on chronic instrumentation of the bladder, asymptomatic (ie, nonpathogenic) bacterial colonization in the bladder is common but not linked to adverse outcomes. Additionally, alterations in neurologic and sensory function after SCI make it difficult for clinicians to discern asymptomatic bacteriuria from acute urinary tract infection requiring antibiotics. Institutional policies for screening urine during SCI annual exams often lead to detection of bacteriuria but create a clinical decision-making challenge when determining whether antibiotic treatment is appropriate. To conduct preimplementation SCI-focused adaptations to the evidence-based practice (EBP) "Kicking CAUTI"-to develop a guide for SCI providers surrounding testing and treatment of CAUTI. Four 1-hour focus groups were conducted with SCI clinicians (prescribers and nursing staff) to assess insights on needed modifications to adapt Kicking CAUTI for SCI. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to plan and report adaptations in this work and the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide adaptation of the EBP for the SCI population. Content and thematic analysis guided our process. The clinical algorithm was simplified, a urinary symptom assessment added, and provider- and patient-facing educational materials were developed to support implementation efforts to create the Test Smart Treat Smart Intervention. Traditional CAUTI protocols do not adequately address the needs of those with SCI and modifications are needed. Provider feedback provides valuable insights when adapting population appropriate interventions.

Development of a rapid, culture-free, universal microbial identification system using internal transcribed spacer targeting primers.

The indiscriminate administration of broad-spectrum antibiotics is a primary contributor to the increasing prevalence of antibiotic resistance. Unfortunately, culture, the gold standard for bacterial identification is a time intensive process. Due to this extended diagnostic period, broad-spectrum antibiotics are generally prescribed to prevent poor outcomes. To overcome the deficits of culture-based methods, we have developed a rapid universal bacterial identification system. The platform utilizes a unique universal polymerase chain reaction (PCR) primer set that targets the internal transcribed spacer (ITS) regions between conserved bacterial genes, creating a distinguishable amplicon signature for every bacterial species. Bioinformatic simulation demonstrates that at least 45 commonly isolated pathogenic species can be uniquely identified using this approach. We experimentally confirmed these predictions on a representative set of pathogenic bacterial species. We also show that the system can determine the corresponding concentration of each pathogen. Finally, we validated performance in clinical urinary tract infection samples.

Xanthogranulomatous pyelonephritis in a child with autoimmune joint disease.

Xanthogranulomatous pyelonephritis is a rare condition in paediatric patients, mostly described in middle-aged female patients. We present a 7-year-old female with juvenile idiopathic arthritis, who was found to have a kidney mass with a concurrent Escherichia coli urinary tract infection. Surgical excision was done out of concern for possible malignancy. Histology confirmed the diagnosis of xanthogranulomatous pyelonephritis and persistent E. coli infection.

How Do Surgical Interventions for Neurogenic Lower Urinary Tract Dysfunction Impact Quality of Life?

Adult patients with neurogenic lower urinary tract dysfunction (NLUTD) often have urinary symptoms that impact their quality of life (QOL). Our objective is to identify and summarize studies evaluating QOL changes across different NLUTD surgical interventions. A systematic rapid evidence review was carried using EMBASE and MEDLINE. We included adult patients (> 18 years old) with NLUTD who underwent a relevant surgery and had a measurement of QOL. We included pre-post study designs (primary focus) and cross-sectional studies (secondary focus). Studies were reviewed and data extracted by multiple assessors. Standardized data extraction tables were used, and qualitative synthesis was performed. Of the 1074 screened articles 26 were included. There were 3/15 studies that evaluated reconstructive surgery (augmentation and/or catheterisable channel) pre-post intervention (n = 94 patients); there was a 7%-28% relative improvement in bladder related and overall QOL using validated questionnaires, and a large magnitude of improvement in studies using unvalidated questionnaires. There were 3/7 studies that looked at urinary diversion pre-post intervention (n = 153 patients) and showed an approximately 20%-60% improvement in validated questionnaires assessing bladder specific quality of life, and 0%-25% improvement in overall quality of life. Finally, 3/4 studies were pre-post stress incontinence surgeries (n = 67 patients) and they found an improvement in the ICIQ questionnaire scores and study-specific questionnaires. The literature supporting a change in QOL in adult NLUTD patients undergoing surgical interventions is extremely limited due to a lack of pre-post studies, and the frequent use of unvalidated outcome measures.