Genitourinary Tract Disorders Research Articles

Abstract 6480: In-hospital mortality risk factors for uveal melanoma patients in the emergency department

Abstract Purpose: A considerable amount of uveal melanoma patients present to the emergency department (ED) for a complication related to their primary tumor. However, there is not much research into the primary reasons for these patients to present to the ED and their outcomes. Methods: The Nationwide Emergency Department Sample was queried from the last quarter of 2015 to 2019 to identify patients with a diagnosis of uveal melanoma. Multivariable logistic regression, with patient- and hospital-level characteristics as covariates, was used to identify factors associated with increased risk of in-hospital death. Results: From the last quarter of 2015 to 2019, there were 7,561 ED encounters with a secondary diagnosis of uveal melanoma. Most patients were at least 65 years of age (43.5%), male (52.5%), and a Medicare beneficiary (44.2%), or belong to a family in the 3rd income quartile (25.6%). The median age of these patients was 61 years (IQR: 32-74). Most patients presented to hospitals in the South (40.8%), with a Trauma Level I designation (47.2%), and to a metropolitan teaching hospital (72.6%). The most common diagnosis for presentation to the ED were the following general clinical categories: blood disorders (7.1%), genitourinary tract disorders (5.1%), infections (6.0%), respiratory diseases (9.0%), nervous system disorders (4.8%), endocrine/nutrition disorders (4.3%), and vascular disorders (8.3%). The rate of metastatic uveal melanoma was 5.8%. The rate of in-hospital mortality was 3.6%. In a multivariable logistic regression identified the following clinical categories as factors associated with a higher risk of in-hospital death: infections (odds ratio [OR]=10.22; p<0.001), metastases (OR=10.22; p<0.001), genitourinary tract disorders (OR=7.05; p<0.001), respiratory diseases (OR=3.31; p=0.031), and vascular disorders (OR=3.14; p=0.044). Nervous system, blood, and endocrine/nutrition disorders were not associated with a higher rate of in-hospital mortality. The only demographic variable associated with a higher risk of in-hospital death was being part of the top income quartile (OR=3.10; p=0.14). Conclusion: Physicians have to be mindful of different complications associated with uveal melanoma that can lead to presentation to the ED and possible in-hospital death. Specifically, physicians need to be mindful of infections, metastases, genitourinary tract disorders, respiratory diseases, and vascular disorders in these patients. Citation Format: Alice A. Beneke, Kamil Taneja, Lauren Ladehoff, Kevin Root, Eric Toloza. In-hospital mortality risk factors for uveal melanoma patients in the emergency department [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6480.

Preliminary phytochemical, physico-chemical & HPTLC analysis of aanai nerunjil kudineer

The Siddha system is an Ancient and Indigineous system of medicine followed predominantly by the people of South India. It comprises of various modes of treatment for a number of diseases. Aanai Nerunjil kudineer is a herbal drug which is indicated for many common Genito-Urinary tract disorders in the textbook, Gunapadam Mooligai vaguppu (Siddha Materia Medica). Aanai Nerunjil (Pedalium murex) plants and Seeds of Kothumalli (Coriandrum sativum) were collected from the locality of Tuticorin, Tamilnadu and were dried under sunshade and ground into coarse powder and then mixed in a 4:1 ratio respectively. Aqueous alcoholic Extracts of the powder was made by Hot soxhlet method. Alkaloids, Terpenoids, Glycosides were found to be present in preliminary phytochemical investigation. The Physico-chemical analysis revealed that the LOD at 1050c was 8.4%, Total Ash value as 10.84%, acid insoluble ash as 0.85%, water soluble ash as 3.25%, sulphated ash as 14.56%, pH of 4% aqueous solution as 8.08, volatile oil content of 0.5%.HPTLC was performed in aqueous alcoholic extract at 254nm, 366nm & 575nm and the chromatograms were recorded. The Rf peak values were found to be significant which can further assist in identification of the individual compounds. Keywords: siddha medicine, pedalium murex, coriandrum sativum, preliminary phytochemical, physico chemical, HPTLC Analysis Introduction The World Health Organization has estimated that about 80% of earth's inhabitants rely on traditional medicine for their primary health care needs that primarily involves the use of plant extracts or their active components.1 Over 248, 000 species of higher plants have been identified and from these 12, 000 plants are known to have medicinal properties.2The importance of plants is known to us well. The plant kingdom is a treasure house of potential drugs and in the recent years there has been an increasing awareness about the importance of medicinal plants[3].

Tribulus Terrestris: An Important Medicinal Herb of Indian Desert

Abstract: Tribulus terrestris L. (Family Zygophyllaceae), commonly known as Small Caltrops or Chhota Gokhru, growing wildly in sandy areas is known for its medicinal uses in traditional medicine system. The fruit, leaves, stem and root of the plant are used medicinally. T. terrestris possessed many pharmacological attributes such as nephroprotective, aphrodisiac, antiinflammatory, anti-oxidant, antimicrobial and insecticidal activities. These marvellous bioactivities of the T. terrestris can be attributed to the presence of a wide range of phytochemicals including flavonoids, flavonol glycosides, steroidal saponins, and alkaloids. The dried fruit of the herb is very effective in most of the genitourinary tract disorders. The present study highlights the potency of T. terrestris in controlling the reproductive disorders, mainly impotence, nocturnal emissions, erectile dysfunction in men and gonorrhoea in women. In addition, it acts as a diuretic and provides remedy for urinary tract disorders. The present study provides a comprehensive overview of the phytochemistry, folk medicinal uses and pharmacological aspects of T. terrestris. The information will be helpful in developing the new formulation with therapeutic and economic value in the future.

Do uroflowmetry and post - void residual urine tests necessary in children with primary nocturnal enuresis?

ABSTRACTObjectives:To examine the benefits of repetitive uroflowmetry and post void residual urine (PVR) tests in children with primary nocturnal enuresis (PNE).Material and methods:Children aged ≥6 years with PNE who visited our clinics for management of enuresis were included for study. Patients were requested to complete a questionnaire including baseline characteristics and Dysfunctional Voiding Symptom Score (DVSS), 2-day bladder diary, and Rome III criteria for constipation. Two uroflowmetry and PVR tests were requested. Children with congenital or neurogenic genitourinary tract disorders were excluded. All children underwent urotherapy and desmopressin combined with anticholinergics or laxatives if indicated. The definition of abnormal flow patterns (≥1 abnormal), elevated PVR (≥1 abnormal), small maximal voided volume (MVV), nocturnal polyuria (NP) and response to treatment complied with the ICCS standardization document. Kaplan-Meier survival analysis and Cox proportional-hazards regression tests were used to evaluate the predictors of response.Results:In total, 100 children aged 8.5±2.3 years were enrolled for study (M: F=66:34) with 7.3±7.4 months of follow-up. Poor correlation was observed between DVSS/small MVV and PVR (p>0.05). Univariate analysis revealed that elevated PVR is associated with significantly less hazard of complete response to medical treatment (HR: 0.52, p=0.03), while not significantly associated with abnormal flow patterns, NP, constipation or small MVV. Multivariate analysis revealed that only elevated PVR (HR 0.30, 95% CI 0.12-0.80) and NP (HR 2.8, 95% CI 1.10-7.28) were significant predictors for complete response.Conclusions:In managing pediatric enuresis, elevated PVR is a significant predictor for lower chance of complete response to treatment whether they had high DVSS or not.

The Role of the Hydrogen Sulfide Pathway in Male and Female Urogenital System in Health and Disease.

The endogenous hydrogen sulfide (H2S) pathway produces an array of biological effects that vary depending on the bodily region. In addition, the H2S pathway's relevance often changes depending on a healthy or disease state. There is abundant evidence pointing to a key role for this pathway in male and female genito-urinary diseases, suggesting it as a possible target for new therapeutic approaches. Recent Advances: The tissue-specific localization of the H2S enzymes in the genito-urinary tract has allowed for a better understanding of its role in the body's pathophysiology. Indeed, in humans, cystathionine-γ-lyase (CSE) plays a major role in corpus cavernosum whereas cystathionine-β-synthase (CBS) plays a role in bladder functioning. The prostate epithelium expresses CBS and CSE, but stromal CSE only. In the uterus, up- or downregulation of CBS and CSE varies strongly depending on the female's hormonal cycle or pregnancy. There is still the need to better define the male and female's sexual hormonal roles in regulating the H2S pathway, particularly in human pathological conditions. The lack of a correlation between human and animal data should be carefully considered when planning preclinical studies. The unmet need for selective enzymatic inhibitors and the different methodologies for H2S measurements still represent a critical issue in this research field. It is feasible that the L-cysteine/H2S pathway can represent an alternative therapeutic target in genito-urinary tract disorders. The research should focus on erectile dysfunction and preeclampsia, characterized by vascular defect, as well as on bladder disorders where the urothelium is compromised. Antioxid. Redox Signal. 27, 654-668.

Outcome of sonographically suspected fetal ovarian cysts

Objective: Fetal ovarian cysts (FOCs) are the most common intra-abdominal cystic structures formed during antenatal period. The aim of this study was to evaluate prenatal characteristics and postnatal outcome of sonographically suspected FOCs.Methods: We reviewed prenatal sonographic data and postnatal medical records of 29 fetuses that were suspected to have ovarian cysts in our hospital, between January 2001 and September 2012. Perinatal outcomes were obtained for all cases.Results: In a total of 29 cases, we confirmed initial antenatal diagnosis of ovarian cyst in 20 cases (68.9%) at postnatal period. Diagnosis of remaining nine cases revealed urogenital sinus anomaly in four cases, multicystic dysplastic kidney in two cases, mesenteric cyst in one case, intestinal duplication cyst in one case and lymphangioma in one case postnatally. In seven of the 20 ovarian cysts (35%), resolution of the cyst occurred prenatally. Intrauterine death of a fetus occurred at second trimester. In the postnatal period, most often cases (11/20) were spontaneously resolved and surgery was performed on two babies due to ovarian torsion (2/20).Conclusion: Differential diagnosis of FOCs should always include genitourinary tract disorders, gastrointestinal tract disorders and other intra-abdominal cystic structures.

Genitourinary Conditions in Young Dancers: Relationship between Urinary Incontinence and Foot Flexibility

Research into dance pathology usually focuses on musculoskeletal and endo-crine-nutritional conditions. However, when practiced full time other systems can also be affected. The aim of this work was to determine the prevalence of genitourinary conditions in dance and to establish whether any correlation exists between stress urinary incontinence (SUI) and the cushioning capacity of the foot. A total of 32 pre-professional dancers (27 females and 5 males; 19 ± 2.2 years old) who practiced several types of dance in the Madrid Professional Conservatoire of Dance were studied. The data were obtained using a questionnaire, personal interviews, and physical examination. The height of the internal plantar arch of both feet was measured before and after training, estimating the flexibility of the plantar arch (percentage change in height of arch between both situations). Multiple regression analysis was used to analyze the existence of a possible relationship between SUI and plantar flexibility. A total of 68.7% of dancers had suf-fered a genitourinary condition at some time during their lives, and 48.1% of the female dancers and 20% of the males had suffered SUI. SUI was triggered by dance in 69.2% of the females with urinary incontinence, and was considered as problematic by 30.7%. SUI occurs during the classes in 55% of cases, mainly during ballet activities, followed by flamenco tap dancing. SUI associated with dance is more closely related to the flexibility of the plantar arch in basal conditions (r2 = 0.64, p < 0.05, t-stat = 3.57) and after training (r2 = 0.76, p < 0.05, t-stat = 3.52), than that presenting in diverse situations (r2 = 2.07, p < 0.05, t-stat = 3.1), for which other causal factors must be sought. Lower genitourinary tract disorders are more prevalent in pre-professional dancers than in the general population; and dance itself is the main triggering factor of SUI. We, therefore, recommend that more attention be paid to the genitourinary system in dance medicine and propose a series of preventive measures.

Current Trends in Lower Urinary Tract Health Highlights From Annual Advances in Genitourinary Health: A Scientific Update

S ignificant progress has been made in recent years in the understanding and management of lower genitourinary tract disorders. Such advances pertain to common voiding disorders as well as to sexual function disorders occurring in both men and women. OAB has received considerable clinical and academic attention in recent years, which has led to a better understanding of the condition. One of the more significant developments has been the revised definition of OAB of the International Continence Society, characterizing it primarily by its symptom of urinary urgency. Patients with OAB may or may not experience UI, but the majority experience micturition frequency and nocturia. Regardless of whether incontinence is present, OAB has the potential to significantly impair quality of life in an individual. Embarrassment leads many patients to avoid social interaction, and the common misconception that UI is an unavoidable part of the aging process prevents many from seeking treatment. Sexual dysfunctions in men and women have come to light as major quality of life issues but also as public health concerns. Sexual dysfunction may have both physical and emotional causes, which may coexist in the same patient and, like UI, it is frequently an embarrassing condition for patients to address, both with their physician and their partner. This supplement to The Journal of Urology® summarizes some of the critical research data and other materials presented October 22 to 23, 2004 at Annual Advances in Genitourinary Health: A Scientific Update in Chicago, Illinois. The purpose of the meeting was to bring practitioners from various fields of medicine together, including urologists, gynecologists and urogynecologists, primary care specialists, and clinicians of all types, to discuss and exchange up-to-date information in an interactive and scholarly forum. The focus of the Scientific Update was broad, including lower urinary tract symptoms in men and women, sexual dysfunction, guidelines for managing urological cancers, and surgical issues in obstetrics and gynecology; and it included a State-of-the Art Lecture in Complementary Medicine for Men. The authors of the following review

Mental disorders and health care seeking in Bandiagara: a community survey in the Dogon Plateau.

A two-level community study was carried out among the Peul and Dogon populations of the Bandiagara plateau (Mali). For the purpose of the study the Questionnaire pour le depistage en santé mentale (QDSM), a 23-item screening questionnaire derived from the Self-Reporting Questionnaire (SRQ), was adapted and validated; internal consistency and accuracy were evaluated. In the first phase of the study, 466 subjects randomly selected on a residential basis were evaluated by means of the QDSM. In the second phase all subjects who were "positive" at the screening, as well as a sample who were "negative", were examined by means of a semistructured interview. When necessary, clinical and laboratory investigations were performed. The estimated prevalence of psychiatric cases was 6.4%. A significant risk was associated with age and education. Somatic diseases frequently associated with psychiatric disorders were genitourinary tract disorders, tuberculosis and disabling cardiopathies. The main factor determining the seeking of medical help either through traditional of conventional health systems was the presence of a somatic disorder. The presence of a true minor psychiatric disorder, however, was often associated with divining practices.

Comparison of Oxybutynin and its Active Metabolite, N-Desethyl-Oxybutynin, in the Human Detrusor and Parotid Gland

To compare in vitro the antimuscarinic effect of oxybutynin and its active metabolite, N-desethyl-oxybutynin, on human detrusor, and their binding characteristics in detrusor and parotid gland. Antimuscarinic effect in the detrusor was assessed as the ability of the drugs to inhibit carbachol-induced contractions and contractions induced by electrical nerve stimulation. In addition, the drugs' ability to displace 3H-QNB from muscarinic receptors was investigated. Both oxybutynin and N-desethyl-oxybutynin caused a rightward shift of the concentration-response curve for carbachol without depression of the maximum, indicating a competitive antagonism. The pA2 values were 7.8 for oxybutynin and 7.6 for N-desethyl-oxybutynin. Contractions induced by electrical nerve stimulation were depressed by 87% by oxybutynin (10 microM) and by 91% by N-desethyl-oxybutynin (10 microM). In radioligand receptor binding studies on the detrusor, oxybutynin and N-desethyl-oxybutynin had uniform displacement curves and the same pKi value, 8.2. The affinity for N-desethyl-oxybutynin in the parotid gland was significantly higher, the pKi value being 8.7. The corresponding figure for oxybutynin was 8.5. We conclude that oxybutynin and N-desethyl-oxybutynin have a similar antimuscarinic effect in the human detrusor, and the same binding characteristics in detrusor and parotid gland, respectively.

Assessment and management of genitourinary tract disorders

This article reviews the basic anatomy and physiology of the genitourinary system and disorders commonly encountered in the primary care setting. The role of the nursemidwife in the assessment and treatment or referral of complaints of dysuria, hematuria, and incontinence is discussed. The treatment of nonpregnant women with cystitis is addressed; symptoms associated with pelvic relaxation are discussed, and a management scheme for teaching effective pelvic floor exercises is presented.

Genitourinary tract pathology. A condensed updated version of the Atlas of Genitourinary Tract Disorders (1988)

Genitourinary tract pathology. A condensed updated version of the Atlas of Genitourinary Tract Disorders (1988)

Androgens lower prostaglandin E2 levels in neonatal mouse bulbourethral gland in in vitro cultures.

The neonatal mouse bulbourethral gland (BUG) in vitro culture model is useful to study hormone-induced genitourinary (GU) tract growth and differentiation. Like the prostate, the BUG is a derivative of the urogenital sinus and may have relevance to understanding growth processes involved in normal and pathological GU tract development. Previous studies have reported androgen-induced elevation of prostaglandin E2 (PgE2) levels in mouse GU tract in vivo. PgE2 has been proposed to mediate neonatal GU tract masculinization. In our studies, tissues were obtained from neonatal male mice and cultured in serum-free Dulbecco's Modified Eagle's Medium-Ham's F-12 Medium (1:1) supplemented with varying concentrations of androgen. PgE2 levels were measured by RIA in the medium, and tissue specimens were cultured for 7 days or less. During this period, androgens induced proliferation and glandular morphogenesis in the BUGs. In the absence of androgen, tissue and medium PgE2 levels increased over 7 days. Significant (P < 0.05) PgE2 increases over day 1 control values were observed from days 5-7 in tissues and on day 7 in media. During this same time period, androgen supplementation decreased PgE2 levels. Significant (P < 0.05) PgE2 decreases from day 1 cultures were observed from days 3-7 in tissues and on day 7 in media. PgE2 was decreased significantly (P < 0.05) by androgen compared to control values from days 3-7 in tissues and from days 5-7 in media. On day 7 of culture, PgE2 levels were significantly (P < 0.05) inhibited by androgen in a concentration-dependent fashion in tissues and media. Maximal androgen-induced inhibition of PgE2 levels was 96% and 99% in tissues and media, respectively. Although the addition of indomethacin to control cultures markedly inhibited PgE2 production, BUG morphology was unaffected. In addition, the morphology of androgen-stimulated BUGs does not appear to be affected by the addition of exogenous PgE2. We conclude that although androgens induce development and decrease PgE2 levels, PgE2 does not appear to play a major role in in vitro BUG postnatal growth and morphogenesis. The BUG in vitro culture model may mimic growth and morphogenetic processes occurring in the human GU tract. Further understanding of the role of steroid hormones and PG metabolism may yield additional insight into developmental and proliferative GU tract disorders.

Atlas of Genitourinary Tract Disorders

Atlas of Genitourinary Tract Disorders

Retroperitoneal and pelvic CT of patients with AIDS: primary and secondary involvement of the genitourinary tract.

Although genitourinary tract disorders are common in acquired immunodeficiency syndrome (AIDS), little attention has been paid to their manifestations on computed tomographic (CT) scans. The authors reviewed the CT scans of 86 patients infected with the human immunodeficiency virus for CT manifestations of primary or secondary involvement of the genitourinary tract. Genitourinary tract abnormalities identified in the 86 patients included nephromegaly in 34 (40%), hilar adenopathy in 30 (35%), bladder wall thickening in 19 (22%), medullary hyperattenuation in 12 (14%), renal calcifications in seven (8%), adnexal masses in five (6%), hydronephrosis in four (5%), pyelonephritis in three (3%), renal abscesses in three (3%), and solid renal masses in three (3%). Although these abnormalities are seen on CT scans in many other diseases, in the AIDS patient they often indicate the presence of an AIDS-related renal disease or involvement of the genitourinary tract by an AIDS-related neoplasm or infection.

Current Concepts in the Treatment of Genitourinary Tract Disorders in the Older Individual

Genitourinary problems, including neurogenic dysfunction, impotence, prostatism, urinary tract infections, and prostate cancer, are common in the elderly, and most of the symptoms can be alleviated through pharmacological management. Patients with neurogenic dysfunction who present with symptoms such as incontinence and urinary retention can be appropriately managed with bladder and sphincter relaxants or stimulants. Anticholinergic agents in the form of oxybutynin, flavoxate, and propantheline are effective bladder relaxants, and phenoxybenzamine, prazosin, and terazosin are commonly used as sphincter relaxants. Bethanechol chloride is the agent most commonly used to stimulate bladder contraction, but physicians should be careful when prescribing it for elderly patients with cardiovascular problems. Organic and psychogenic causes of impotence usually overlap, and oral agents have limited use in the treatment process. The use of yohimbine has increased recently, but its value and rate of success remains questionable. Testosterone is being used widely to treat impotence, but it is only helpful to patients with hypogonadism and should be used with discretion in the elderly, who have a high incidence of prostate cancer. Vasoactive intracavernous pharmacotherapy, on the other hand, is a recently discovered alternative to testosterone with promising results. Although the treatment of choice for benign prostatic hypertrophy is surgery, there have been important pharmacological advances in treating this disorder. alpha-Adrenergic antagonists and anti-androgenic agents have been found to relieve the symptoms of prostatic enlargement. The use of chemotherapeutic and antibiotic agents to treat and suppress acute and chronic urinary tract infections is reviewed; these are second only to pulmonary infections as the most frequent cause of febrile episodes in patients over the age of 65. Lower urinary tract infections can be treated with almost any antibacterial agent. Upper urinary tract infections require full genitourinary evaluation and appropriate antibiotics should be used according to the urine culture sensitivity studies. With the advent of new hormonal agents, more choices are now available for the management of prostate cancer, which is the second most common malignancy in men. Diethylstilbestrol (stilboestrol), an oral estrogen, remains a commonly used agent to achieve castrate levels of androgens in advanced prostatic carcinoma. Agonist analogues, such as goserelin and leuprorelin, of gonadotrophin-releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH); or gonadorelin] achieve the same results as diethylstilbestrol but without the cardiovascular side effects. Antiandrogens are also being used in combination with GnRH agonists to produce complete androgen blockage, with mixed results.

Atlas of Genitourinary Tract Disorders

Atlas of Genitourinary Tract Disorders

Eosinophiluria

Screening for eosinophiluria is widely held to be useful in the diagnosis of drug-induced acute interstitial nephritis. Hansel’s stain has been shown to be superior to Wright’s stain for the identification of urine sediment eosinophils. However, eosinophiluria is not specific for the diagnosis of acute interstitial nephritis and can occur in a wide variety of genitourinary tract disorders

Arylsulfatase A in urine of patients with urothelial tumors

A significant increase in urine arylsulfatase A activity (p less than 0.01) was found in patients with urothelial tumors. Arylsulfatase A activity was 1.36 +/- 1.10 U/24-h urine in control specimens, 1.90 +/- 1.66 U/24-h urine in various genitourinary tract disorders, and 3.90 +/- 1.98 U/24-h urine in transitional cell carcinoma specimens. Surgical treatment of the neoplastic patients lowered the arylsulfatase A activity found in urine to within reference values. The arylsulfatase A excreted by patients with these tumors was highly sensitive to thermal inactivation while the enzyme activity in the control urines was less affected by the heat treatment. The time course of the arylsulfatase A reaction with 4-nitrocatechol sulfate was not linear in normal individuals, while it was linear in 90% of patients with urothelial tumors. This difference in the kinetic pattern of the enzyme could be used to increase the diagnostic specificity of the determination.

Neonatal obstructive uropathy.

Neonatal obstructive uropathy is the leading cause of renal failure during infancy. A variety of upper and lower genito-urinary (GU) tract disorders may cause obstructive uropathy. The prompt diagnosis and evaluation of obstructive uropathy is imperative since appropriate intervention and follow-up can lead to excellent early recovery of function. The role of in utero diagnosis is primarily to alert physicians to the presence of obstructive uropathy and permit rapid initiation of care at birth or earlier in certain instances. The GU tract must be evaluated for evidence of dilatation, for reflux and for renal function using radionuclide studies, voiding cystourethrograms, cystoscopy and pyelography. The early course of neonatal obstructive uropathy has been improved by institution of GU diversion and primary repair, yet the effect of early surgical intervention and medical therapy in preventing renal failure remains unclear. Further studies are needed to identify prognostic features heralding progression to renal failure and how such progression can be prevented.