Genitourinary Disorders Research Articles

CT characterisation of the feline os penis.

The aim of this study was to investigate the frequency of identification and to describe the CT features of the os penis in cats without genitourinary disorders. CT studies from cats that underwent an abdominal or pelvic examination between October 2013 and May 2019 were reviewed retrospectively. Cats with no signs of urinary disease and with the external genitalia included in the scan were recruited. Length, width, height and pre- and post-contrast attenuation values of the os penis in soft tissue and bone algorithms were measured independently by two observers. Twenty-three cats met the inclusion criteria. A cylindrical bone-attenuating structure inside the glans penis compatible with the os penis was visible in 20/23 (87%) cats. Mean length, width and height values were 3.48 mm × 1.41 mm × 1.37 mm in the soft tissue algorithm, and 3.26 mm × 1.15 mm × 1.06 mm in bone algorithm. The size of the os penis was not significantly different in neutered vs intact cats, but it was significantly larger in soft tissue vs bone algorithm. Age and body weight did not influence os penis size. Pre-contrast mean ± SD attenuation was 216.7 ± 69.5 Hounsfield units (HU) for soft tissue and 320.1 ± 135.9 HU for bone algorithms. Post-contrast attenuation was 289.1 ± 68.8 HU for soft tissue and 383.4 ± 130.9 HU for bone algorithms. A significant correlation between the attenuation in bone algorithm with body weight was noted, where the os penis was less attenuating with increased body weight (pre-contrast: r = -0.479; P = 0.038). The feline os penis is commonly seen on CT images, being more frequently detected than on radiographs. Its presence should not be mistaken for uroliths in the penile urethra.

Impact of Adjuvant Radiotherapy on Survival of Patients with Pathological High-Risk Muscle Invasive Bladder Cancer: A Propensity Scored Match Paired Analysis

Radical cystectomy (RC) and pelvic lymph-node dissection (LND) is standard treatment for non-metastatic muscle-invasive urothelial bladder cancer (MIBC). However, loco-regional recurrence (LRR) is a common early event associated with poor prognosis. We tested the hypothesis that the impact of adjuvant radiotherapy (aRT) on oncological outcomes in these individuals is related to tumor characteristics. We retrospectively evaluated 490 patients with muscle invasive bladder cancer (MIBC) with a pT3-4 and/or N+ and/or positive surgical margins (PSM) disease treated with RC with or without aRT between 2000 and 2013 at five tertiary care centers. A 1:1 propensity score matched cohort was built to adjust for age, gender, and neoadjuvant chemotherapy. Multivariable Cox regression analyses on the matched cohort tested the relationship between aRT and LRR, cancer specific mortality (CSM) and overall mortality (OM). 5 years-recurrence-free survival risk stratification-tree analysis was built on the whole matched cohort. Acute Gastro-Intestinal (GI), Genito-Urinary and Blood Count Disorders (BCD) toxicities were recorded according to CTCAE V4.0 scale. Median follow-up was 25 months (Interquartile range: 11-55). Overall, 16% of patients received aRT. At multivariable analysis, aRT was associated with more favorable RR rate (hazard ratio [HR] 0.49, 95% Confidence Interval [CI]: 0.24-0.99), p=0.04). When patients were stratified into risk groups, only those with PSM benefited from aRT. These results were confirmed when 5-years recurrence-free survival was examined as an end point. Moreover, 5 % and 4 % of patients presented grade > 2 acute GI or GU toxicities, respectively. Because of poor prognosis, an effective post-operative standard of care is needed for pathological high-risk MIBC. aRT seems feasible and may have oncological benefits. Prospective trials evaluating this approach with current RT techniques should be undertaken.

Prevalence and Risk Factors of Urinary Tract Infection among Pregnant Women in Shahrekord, Iran

Background and aims: This study aimed to determine the prevalence of urinary tract infection (UTI) among the pregnant women and the risk factors related to it in Shahrekord, Iran. Methods: In this cross-sectional study, 832 patients were examined during 26 to 30 weeks of pregnancy and their UTIs were studied. The required information was collected by examining the personal pregnancy health records and completion of the data registration forms. All statistical analyses were performed in SPSS software version 23.0 using chi-square and independent t test. Results: According to the results of this study, out of 832 pregnant women, 109 were diagnosed with UTI; hence the prevalence of UTI was recorded to be 13.1% in this study. Moreover, there was a significant relationship between UTI and variables of delivery, severe nausea and vomiting during pregnancy (known as morning sickness), genitourinary disorders, infertility, and blood group. Conclusion: According to the study results, it seems that screening and treatment of UTIs have been done appropriately and in the right time, in health systems of the city of Shahrekord which have led to the reduction of disorders in infants, as well as maternal diseases. Even in the absence of any UTIrelated symptoms, screening tests for UTI are recommended

Size-tunable Au@Ag nanoparticles for colorimetric and SERS dual-mode sensing of palmatine in traditional Chinese medicine

Palmatine is a protoberberine alkaloid separated from several plants and application as an anti-inflammatory and antibacterial agent in the therapy of gastrointestinal and genitourinary disorder. Thus, the fast quantification of palmatine is important in clinic medical assays. Herein, we report simple, fast and sensitive colorimetric visualization and surface-enhanced Raman spectroscopy (SERS) dual-mode detection of palmatine basing on bimetallic size tunable silver shell capped gold nanoparticles (Au@Ag NPs). Interesting, the best signals output for dual-mode sensing of palmatine were both 5 nm Ag shell thickness of Au@Ag NPs. Meanwhile, we found that the addition of NaHSO4 significantly improves the aggregating sensitivity of Au@Ag NPs to trace palmatine. Upon exposure to 0.1 μM level palmatine, NaHSO4-optimized Au@Ag NPs solution exhibits a highly sensitive color change from orange to green and rapid aggregation kinetics within the initial 5 min, which can directly be seen with the naked eye and monitored by UV–vis absorbance spectra. In addition, we measured palmatine by SERS with the excellent enhancement effect of Au@Ag NPs for further increase the sensitivity and selectivity. More importantly, other protoberberine alkaloids do not interfere with this dual-mode sensor due to the different interaction force between Au@Ag NPs and these alkaloids, and the applicability of the sensor is well demonstrated in real samples with satisfactory results. This provide a fast and simple assay for the rapid detection of palmatine in traditional Chinese medicine, the limit of detection (LOD) is 0.13 μM by the naked eye and 0.10 μM by UV–vis spectroscopy. Therefore, the size-tunable of NaHSO4-optimized Au@Ag NPs can be used not only as a naked-eye sensor of palmatine, but also as a highly selective SERS probe.

Predictors of readmission and long length of stay in elders admitted with neurological disorders in a tertiary center: a real-world investigation.

Hospital readmission and long length of stay (LOS) increase morbidity and hospital mortality and are associated with excessive costs to health systems. This study aimed to identify predictors of hospital readmission and long LOS among elders with neurological disorders (NDs). Patients ≥ 60 years of age admitted to the hospital between January 1, 2009, and December 31, 2010, with acute NDs, chronic NDs as underpinnings of acute clinical disorders, and neurological complications of other diseases were studied. We analyzed demographic factors, NDs, and comorbidities as independent predictors of readmission and long LOS (≥ 9 days). Logistic regression was performed for multivariate analysis. Overall, 1,154 NDs and 2,679 comorbidities were identified among 798 inpatients aged ≥ 60 years (mean 75.8 ± 9.1). Of the patients, 54.5% were female. Patient readmissions were 251(31%) and 409 patients (51%) had an LOS ≥ 9 days (95% confidence interval 48%-55%). We found no predictors for readmission. Low socioeconomic class (p = 0.001), respiratory disorder (p < 0.001), infection (p < 0.001), genitourinary disorder (p < 0.033), and arterial hypertension (p = 0.002) were predictors of long LOS. Identified risks of long LOS explained 22% of predictors. Identifying risk factors for patient readmission are challenges for neurology teams and health system stakeholders. As low socioeconomic class and four comorbidities, but no NDs, were identified as predictors for long LOS, we recommend studying patient multimorbidity as well as functional and cognitive scores to determine whether they improve the risk model of long LOS in this population.

URINARY INCONTINENCE IS MORE COMMON IN ADOLESCENT FEMALE ATHLETES WITH LOW ENERGY AVAILABILITY

BACKGROUND: Female Athlete Triad (Triad), an interrelated syndrome of low energy availability (EA), menstrual irregularity, and low bone mineral density. A broader, more comprehensive term was recently introduced by the International Olympic Committee: ‘Relative Energy Deficiency in Sport’ (RED-S). RED-S includes Triad, but also highlights the multiplicity of complex health and performance consequences of low EA and emphasizes that male athletes are also affected. The syndrome RED-S refers to impaired physiological function caused by relative energy deficiency including menstrual function, metabolism, bone health, immunity, protein synthesis, and cardiovascular health. Low EA has independent negative effects on reproductive function and gonadal steroid production. Urinary incontinence (UI) has many risk factors, including estrogen deficiency (which can be caused by low EA), depression, and participation in high-impact activities. A high prevalence of UI has been reported in female athletes participating in a variety of different sports. To date, research evaluating low energy availability as an independent risk factor for UI has been limited, particularly in a young female athlete population. The purpose of this study was to evaluate the association of UI and low EA in adolescent female athletes. METHODS: 1000 female athletes (ages 15–30 years) presenting to a sports medicine clinic completed a 476 question survey covering topics related to relative energy deficiency in sport (RED-S), including female athlete triad risk factors and athletic activity. For the purpose of this study, data was extracted from responses by subjects between 15–19 years of age. Low EA was defined as meeting = 1 criterion: self-reported history of eating disorder/disordered eating (ED/DE), high score on the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and/or high score on the Eating Disorder Screen for Primary Care (ESP). UI was assessed through a modified form of the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence (ICIQ-UI Short Form). Descriptive statistics are expressed as mean ± standard deviation and associations between EA status and UI queries were assessed by chi-squared analysis (cut off for statistical significance was defined as: p&lt;0.05). RESULTS: Of those who completed the survey, 70.8% were adolescents between 15 and 19 years of age. UI during athletic activities was reported by 14.4% of these athletes. Of those reporting UI, UI was significantly more common in those with low EA than those with adequate EA (54.9% vs. 45.1%, p=0.003). Age was not associated with UI in this subset (p=0.83). The median onset of UI was 1–2 years prior to completing the survey and the median frequency of UI over the previous year was reported as weekly. There was no significant correlation between the presence of menstrual dysfunction and UI (p=0.104). CONCLUSIONS: Our findings demonstrate that UI is a common problem among adolescent female athletes, occurring in 14.4% of 15-19 year old female athletes surveyed in this study. UI is more prevalent in adolescent female athletes with low EA in comparison to female athletes with adequate EA. These findings are consistent with those previously observed in studies involving older populations of adult female athletes with eating disorders, where UI was more prevalent in those with low EA in comparison to controls with adequate EA. These findings suggest a potential place for genitourinary disorders in the constellation of impaired physiologic functions considered associated with low EA in athletes/RED-S, and offers a window into a commonly overlooked clinical problem impacting young female athletes.

HTLV: a stigmatizing infection?

HTLV is a virus that affects human T-cells. Brazil is the country of the world with the largest absolute number of HTLV cases. Estimates by the Ministry of Health point to 700,000 to 2 million infected Brazilians. The majority are asymptomatic carriers, but some persons may develop degenerative neurological conditions such as tropical spastic paraparesis, in addition to leukemia and lymphoma. The forms of transmission and clinical manifestations such as progressive motor incapacity, genitourinary disorders, in addition to restriction of maternal breastfeeding, impact daily life and can lead to social discrimination and stigma. The stigma denotes violation of social norms and reinforces prejudice and inequalities. This article aims to discuss the concept of stigma and its repercussions on persons living with HTLV. The discussion is based on a literature review on the theme and the authors' experience with care for persons affected by the infection and illness. The study found that both HTLV carrier status and HTLV-related illness can be stigmatizing for individuals, who feel inferior for being infected with a potentially serious and even fatal disease, although incompletely understood and loaded with derogatory stereotypes. This situation can have negative repercussions on access to health services, treatment adherence, and pursuit of rights. Public policies should help mitigate such stigmatization, ensuring the rights of individuals in a situation of vulnerability due to HTLV in order from them to live as protagonists in the exercise of their civil rights.

High-glucose promotes proliferation of human bladder cancer T24 cells by activating Wnt/β-catenin signaling pathway.

Bladder cancer is the most prevalent genitourinary malignant disorder worldwide. We aimed to observe effects of high-glucose on bladder cancer proliferation and explore the associated mechanisms. Human bladder cancer cell line, T24, was divided into Blank, Control (Ctrl), 10 mmol/l, 20 mmol/l and 30 mmol/l group. T24 cell proliferation was evaluated by using multiple table tournament (MTT) assay and colony formation analysis, respectively. Quantitative Real-time PCR (qRT-PCR) assay was employed to examine mRNA expression of Wnt-5a and β-catenin. Meanwhile, Western blot assay was used to evaluate expression of Wnt-5a and β-catenin protein. The linear regression analysis was utilized to analyze correlation between Wnt-5a/β-catenin expression and T24 cell proliferation. High-glucose significantly enhanced proliferation of T24 cells compared to that of Blank and Ctrl group (p < 0.05). High-glucose significantly promoted colony formation of T24 cells compared to that of Blank and Ctrl group (p < 0.05). High-glucose significantly up-regulated Wnt-5a mRNA and protein expression compared to that of Blank and Ctrl group (p < 0.01). High-glucose significantly increased β-catenin mRNA and protein expression compared to that of Blank and Ctrl group (p < 0.01). Effects of high-glucose on T24 cell proliferation were increased following with the enhanced glucose concentration. Wnt/β-catenin signaling pathway molecules were correlated with colony formation of T24 cells (p < 0.05). High-glucose promoted the proliferation of T24 cells by activating the Wnt/β-catenin signaling pathway. This study would provide the novel targets for bladder cancer therapy.

The Burden of Candidate Pathogenic Variants for Kidney and Genitourinary Disorders Emerging From Exome Sequencing.

Exome sequencing is increasingly being used for clinical diagnostics, with an impetus to expand reporting of incidental findings across a wide range of disorders. Analysis of population cohorts can help reduce risk for genetic variant misclassification and resultant unnecessary referrals to subspecialists. To examine the burden of candidate pathogenic variants for kidney and genitourinary disorders emerging from exome sequencing. Secondary analysis of genetic data. A tertiary care academic medical center. A convenience sample of exome sequence data from 7974 self-declared healthy adults. Assessment of the prevalence of candidate pathogenic variants in 625 genes associated with Mendelian kidney and genitourinary disorders. Of all participants, 23.3% carried a candidate pathogenic variant, most of which were attributable to previously reported variants that had implausibly high allele frequencies. In particular, 25 genes (discovered before the creation of the Exome Aggregation Consortium, a genetic database comprising data from a large control population) accounted for 67.7% of persons with candidate pathogenic variants. After stringent filtering based on allele frequency, 1.4% of persons still had a candidate pathogenic variant, an excessive rate given the prevalence of monogenic kidney and genitourinary disorders. Manual annotation of a subset of variants showed that the majority would be classified as nonbenign under current guidelines for clinical sequence interpretation and could prompt subspecialty referrals if returned. Limited access to health record data prevented comprehensive assessment of the phenotypic concordance with genetic diagnoses. Widespread reporting of incidental genetic findings related to kidney and genitourinary disorders will require stringent curation of clinical variant databases and detailed case-level review to avoid genetic misdiagnosis and unnecessary referrals. These findings motivate similar analyses for genes relevant to other medical subspecialties. National Institute of Diabetes and Digestive and Kidney Diseases and National Human Genome Research Institute.

Patients, Practitioners and Lodgers: Male Sexual Health Patients’ and their Healers’ Use of Location in Early Modern Medical Encounters

Patients, Practitioners and Lodgers: Male Sexual Health Patients’ and their Healers’ Use of Location in Early Modern Medical Encounters

Diagnostics of genitourinary disorders and sexual dysfunctions in women in menopause

In complex clinical examination of 40 women with physiological menopause (group I) and 44 women with surgical menopause (group II) genitourinary disorders were revealed among 25 (62,5%) and 39 (88,6%) patients respectively. Atrophic colpitis was the first manifestation of genitourinary disorders. It was noted that the formation of genitourinary disorders and sexual dysfunctions in women in menopause took place at the background of reduction of nitrite azote and changes of blood flow in genitals, and worsened as menopause developed. In accordance with the results of earlier carried out research an algorithm of early diagnostics of sexual dysfunctions in women in menopause was developed.

Determination of the frequency of genitourinary syndrome of menopause (gsm) and female sexual dysfunctions

The carried out research has shown that menopause, a special state of quality transformation in a woman’s body, caused by the shift in hormonal homeostasis, is an evidential moment of direct dependency between change of concentration of sex steroids and frequency and level of age disorders, namely genitourinary menopausal disorders, sexual dysfunctions. It was established that the average age of the beginning of menopause in the examined women was 49,1±1,22 years. Genitourinary syndrome of menopause, as a feature of medium-term climacteric disorders, was observed in 53,1% of the examined women, while in 127 (36,3%) of the examined these disorders were first established 1–2 years before the menopause, with I degree of complexity in 43 (12,3%) and II degree – in 139 (39,7%). It was noted that among women of menopausal age sexual dysfunctions were established, namely disorders of desire (48,6%), arousal (46,9%), primary (10,6%) and secondary (17,7%) anorgasmia, dyspareunia (49,1%), diagnosed in 72,6% of cases in various combinations. Disorders of sexual health in women of menopausal age were combined with the state of disappointment, reduction of self-esteem and contributed to the disharmony of a couple through «vicious circle». Prevention of these disorders should be carried out systematically and gradually, starting with premenopause in accordance with the principles of interdisciplinary approach.

Association between extreme temperature and kidney disease in South Korea, 2003–2013: Stratified by sex and age groups

Weather conditions due to climate change affect the health directly and indirectly. Previous studies have shown associations with temperature, heat wave, and cold spell, and these do not only result in mortality from cardiovascular disease, respiratory disease, etc., but also in morbidity. This study aimed to quantify the relative risk for hospital admissions related to ambient temperature for genitourinary system diseases, which are representative of metabolic disease. We conducted a nationwide retrospective cohort study using claims data generated by medical services for diseases of the urinary system. The data was based on medical claims data from 16 districts in South Korea, to the nationwide level between 2003 and 2013. A total of 1,255,671 hospital admissions through the emergency department because of diseases of the genitourinary system were reported within the study period. The overall cumulative relative risk at the 99th percentile vs. the minimum morbidity percentile for renal diseases was 1.252 (95% confidence interval 1.211 to 1.294) in Seoul, 1.252 (1.21 to 1.296) in Busan, 1.236 (1.196 to 1.276) in Daegu, 1.237(1.197 to 1.279) in Gwangju, and 1.258 (1.218 to 1.299) in Gyeonggi-do, 1.278 (1.211 to 1.349) in Chungcheongbuk-do, 1.291 (1.235 to 1.35) in Gyeongsangnam-do. In the group of men over 65 years, the overall cumulative RR was high and statistically significant in acute kidney injury (AKI). But we could not find the effect of high temperature for chronic kidney disease (CKD). The association were rather opposite, but not statistically significant. Our nationwide study not only demonstrates relative risk considering lag effects associated with ambient temperature and trends in hospital admissions through the emergency department for genitourinary disorders but also observed differences among disease groups.

Risk Differences in Disease-Specific Infant Mortality Between Black and White US Children, 1968-2015: an Epidemiologic Investigation.

Black/African American (AA) infants have been persistently observed with survival disadvantage compared to White infants in the USA, implying excess mortality. While reliable epidemiologic data continue to illustrate these disparities, data are yet to provide a substantial explanation to the observed rates and risk differences over the past six decades. We aimed in this study to examine the infant mortality risk differences by temporal trends and to provide an ecologic and non-concurrent explanation for the persisted variability. A retrospective design with aggregate data from the Center for Disease Control and Prevention (CDC) was used to access the risk difference in cause-specific mortality, while stratification analysis was utilized for the risk ratio estimation. We also estimated the percent change for mortality trends. The cumulative infant mortality (IM) incidence was two times as likely for Black/AA relative to White, risk ratio (RR), 2.05. There were temporal trends in IM between 1968 and 2015 with excess IM among Black/AA children. Specifically, between 1968 and 2015, the percent change (% change) for digestive system disorders (58.43%); genito-urinary tract system disorders (58.20%); muscle, skeleton, and connective tissue disorders (66.60%); congenital anomalies (23.79%); and certain perinatal causes (38.65%) indicated upward trends in infant mortality Black/AA and White risk ratio. Except for neoplasm, and the initial study period (1968-1978) for congenital anomalies, Black/AA infants indicated survival disadvantage, implying excess mortality ratio relative to their White counterparts. Disease-specific infant mortality is higher among black/AA except for neoplasm, and increasing percent changes are observed in digestive; genito-urinary; and muscle, skeleton, and connective tissue disorders. These findings are suggestive of the pressing needs to examine the cause of these disparities namely social determinants of health and social inequity for specific risk-adapted intervention in achieving health equity in US infant mortality.

Opportunities for prevention and correction of genitourinary menopausal syndrome

In the manifestation and development of urogenital atrophic processes associated with the onset of menopause, the leading role is played by the growing deficiency of estrogens. An important circumstance is the fact that genitourinar menopausal disorders are often accompanied by other climacteric disorders. In this regard, a key place in the prevention and correction of hypoestrogenic conditions is systemic menopausal hormone therapy. Among the representatives of systemic menopausal hormone therapy, clinical efficacy and low risk of possible complications were demonstrated by preparations containing 17b-estradiol in combination with drospirenone. In the literature there is a significant number of publications reflecting the positive effect of these drugs on the condition of women with vasomotor, psychoemotional climacteric disorders, with a decrease in bone mass. Also, these drugs are used in the therapy and prevention of atrophic processes of the urogenital tract. This allows us to apply this combination of hormones in the complex correction of systemic and local genitourinary menopausal disorders.

Послесловие к статье Ю.Э. Доброхотовой, И.Ю. Ильиной и соавт. «Применение эрбиевого лазера в лечении генитоуринарных расстройств» – мнение эксперта

Послесловие к статье Ю.Э. Доброхотовой, И.Ю. Ильиной и соавт. «Применение эрбиевого лазера в лечении генитоуринарных расстройств» – мнение эксперта

Traditional botanical knowledge of medicinal plants in a “quilombola” community in the Atlantic Forest of northeastern Brazil

Plant resources are essential to the survival of the human species, and they play several important roles in maintaining the quality of life. The purpose of this study was to assess the traditional knowledge of medicinal plants in the Ipiranga quilombola community on the south shore of the state of Paraiba, northeast of Brazil. Ethnobotanical data were collected using semi-structured interviews that were performed with the head of the family for all the domestic units in the community (total of 100 individuals). Data were qualitative and quantitative (Use-Value index and informant consensus factor) analyzed. A total of 69 species belonging to 38 families were mentioned by the respondents. Only two medicinal species (Stryphnodendron pulcherrimum (Willd.) Hochr and Handroanthus impetiginosus (Mart. ex DC.) Mattos) are found in the surrounded Atlantic Forest area. All the other medicinal species are cultivated in backyards. The species with the highest Use-Values were Alpinia zerumbet (Pers.) B.L. Burtt. & R.M. Sm. (colony). The medicinal species were indicated for the treatment of 66 diseases, which were classified into 14 categories of body systems. Respiratory system disorders (0.54), gastrointestinal system disorders (0.43), and a genitourinary system disorder (0.42) were the categories with the highest consensus values among the respondents. The research showed that despite having a health center close to the community, the Ipiranga community still uses medicinal plants to cure diseases, with most species being cultivated in backyards.

Haiti's rural Central Plateau: Baseline data from mobile health clinics.

George Washington Students for Haiti conducts mobile clinics in the Central Plateau of Haiti. Baseline health data for specific rural areas of Haiti are needed. Medical teams conducted mobile clinics in rural locations of Haiti's Central Plateau. Diagnoses, blood pressure, growth parameters, medications prescribed, and referrals were recorded. Analyses included 865 patients. The leading pediatric diagnoses were acute respiratory infection, dermatitis, and abdominal pain. Using height for age, 22.9% of children were categorized as malnourished. The primary adult diagnoses were gastroesophageal reflux disease (GERD) (23.3%), genitourinary disorders (15.9%), and cataracts (15.1%). Of all adults, 21.3% had hypertension Stage 1, and 15.4% had hypertension Stage 2. This study provides valuable baseline health data for those providing medical care in the Central Plateau of Haiti. Effective health care targets include intestinal parasitic infections and malnourishment for children; hypertension and GERD for adults.

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.

National audit shows diabetic foot care suffers from variation between services in ulcer outcomes

National audit shows diabetic foot care suffers from variation between services in ulcer outcomes