Genitourinary Symptoms Research Articles

Clinical Relevance of the Nonvisualized Appendix on Ultrasonography of the Abdomen in Children

To evaluate the clinical relevance of the nonvisualized appendix on ultrasound imaging in children with right lower quadrant pain. We reviewed 1359 children admitted for abdominal pain between January and December 2013 who had abdominal ultrasound imaging for right lower quadrant pain. Patients who had scans for genitourinary symptoms or intussusception were excluded from the study. When the appendix was not visualized, secondary signs indicating right lower quadrant inflammatory pathology were noted. Of all admissions for abdominal pain, 810 had ultrasound scans. Thirty-eight did not evaluate the appendix and 131 were excluded for suspected intussusception, leaving 641 reports for children with a median age of 10.8 years (range, 1.3-21.3); 297 were boys (46.3%). There were 17 of 160 patients with a nonvisualized appendix (10.6%) who underwent appendectomy. Of these, 14 had secondary signs on ultrasound imaging and 3 (1.9%) had normal ultrasound reports. The 3 patients with normal ultrasound imaging had computed tomography imaging confirming appendicitis. There were 51 patients with a partially visualized appendix. The segment of appendix that could be seen was normal in 34 patients, none of whom had appendectomy. The remaining 17 had appendectomy, in whom the appendix seemed to be inflamed in 13 and equivocal in 4, all with histologically confirmed appendicitis. Overall, 232 children underwent appendectomy; 58 had no ultrasound imaging done, and 5 had a histologically normal appendix (overall negative appendectomy rate, 2.2%). Only 35 of 1359 patients (0.03%) had computed tomography scans. In patients with a nonvisualized appendix on ultrasound imaging and no evidence of secondary inflammatory changes, the likelihood of appendicitis is less than 2%. Generous use of ultrasonography as an adjunct to clinical examination can achieve low negative appendectomy rates without underdiagnosis of acute appendicitis.

New options for menopausal symptoms after 15 years of WHI Study.

Menopausal symptoms include vasomotor symptoms (VMS), vulvar-vaginal atrophy, and loss of bone mass associated with an increased risk of fracture. Treatment of VMS consists of lifestyle changes, hormone treatment (estrogens with and without progestogens, tissue selective estrogens complex or conjugated estrogens and bazedoxifene [CE/BZA], progestogens, and tibolone), and nonhormonal treatments. Genitourinary symptoms due to vulvar-vaginal atrophy are treated with systemic and local hormones, moisturizer creams and gels, CE/BZA, and a selective estrogen receptor modulator (ospemifene). In addition to lifestyle changes, treatments for the risk of fragility fracture include calcium and vitamin D, hormone treatment, selective estrogen receptor modulators (raloxifene, BZA), bisphosphonates, strontium ranelate, denosumab, and teriparatide. This article reviews treatment options and provides treatment algorithms for women with menopausal symptoms.

Sexual violence cases in a hospital setting in Hong Kong: victims' demographic, event characteristics, and management.

Rainlily, the first one-stop crisis centre in Hong Kong, was set up in 2000 to protect female victims of sexual violence. This study aimed to analyse the characteristics of sexual assault cases and victims who presented to two hospitals in Hong Kong. The data are invaluable for health care professionals and policymakers to improve service provision to these victims. This retrospective analysis of hospital records was conducted in two acute hospitals under the Hospital Authority in Hong Kong. Sexual assault victims who attended the two hospitals between May 2010 and April 2013 were included. Characteristics of the cases and the victims, the use of alcohol and drugs, involvement of violence, and the outcome of the victims were studied. During the study period, 154 sexual assault victims attended either one of the two hospitals. Their age ranged from 13 to 64 years. The time from assault to presentation ranged from 1 hour to more than 5 months. Approximately 50% of the assailants were strangers. Approximately 50% of victims presented with symptoms; the most common were pelvic and genitourinary symptoms. Those with symptoms (except pregnancy) presented earlier than those without. The use of alcohol and drugs was involved in 36.4% and 11.7% of cases, respectively. Approximately 10% of the screened victims were positive for Chlamydia trachomatis. There were 11 pregnancies with gestational age ranged from 6 weeks to 5 months at presentation. Less than half of the victims completed follow-up care. Involvement of alcohol and drugs is not uncommon in sexual assault cases. Efforts should be made to promote public education, enhance coordination between medical and social services, and improve the accessibility and availability of clinical care. Earlier management and better compliance with follow-up can minimise the health consequences and impact on victims.

Factors associated with the over-treatment and under-treatment of gonorrhea and chlamydia in adolescents presenting to a public hospital emergency department

The purpose of this study was to measure the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) and the rates and factors associated with their over-treatment (OT) and under-treatment (UT). A retrospective chart review was performed of patients aged 13-24 years who were screened for GC/CT in the emergency department (ED) of a public hospital. Descriptive statistics were obtained for all variables, and multivariate log binomial regression was performed to ascertain the factors associated with OT and UT. Seven hundred and ninety-seven adolescents and young adults were screened for GC/CT. The overall sexually transmitted infection (STI) positivity rate was 21.6%; 136 (21.6%) subjects were over-treated and 74 (43.4%) subjects were under-treated. Patients presenting with STI exposure or genito-urinary symptoms were more likely to be OT. Additionally, females aged 18-19 years or with a prior history of STIs were more likely to be OT. Females (83.6%) were more likely to be UT, while STI exposure, genito-urinary symptoms, and a prior history of STI were protective of UT . Adolescents and young adults screened for STIs have a high prevalence of GC/CT. A significant proportion of these patients end up over-treated and an even higher proportion are under-treated.

What's new in the world of postmenopausal sex?

The purpose of this review is to describe new terminology for vulvovaginal atrophy and female sexual dysfunction and to highlight recent findings related to vaginal moisturizers, lubricants and prescription estrogen preparations. Sexual health is a marker for overall health. A minority (40%) of healthcare providers routinely ask about sexual problems and its impact on quality of life. New terminology by the American Psychiatric Association divides female sexual disorders into three categories: arousal/interest disorder, orgasmic disorder and genital pain and penetration disorder. First-line therapy for genitourinary syndrome of menopause includes over-the-counter vaginal lubricants and moisturizers, followed by topical estrogen formulations. Progesterones are generally not needed when topical low-dose estrogen is prescribed. A systemic selective estrogen receptor modulator, designed specifically for genitourinary menopausal symptoms, is an option for patients who do not tolerate local estrogen. Female sexual dysfunction is prevalent and causes distress, particularly among women at midlife. Although hypoactive sexual desire disorder may be the most prevalent dysfunction, dyspareunia and pain, particularly related to genitourinary and vulvovaginal atrophy, are also very common. Over-the-counter lubricants and prescription strength estrogen formulations are generally effective and well tolerated.

Salvage external beam radiotherapy for locally recurrent prostate cancer after definitive brachytherapy

PurposePatients with locally recurrent prostate cancer after definitive prostate brachytherapy have few evidence-based salvage options. We evaluate the efficacy and treatment-related side-effects of salvage external-beam radiotherapy (EBRT) after definitive prostate brachytherapy (PBT). Methods and MaterialsEleven patients previously treated with definitive PBT and with biopsy-proven local-only recurrence received salvage reirradiation with EBRT. Genitourinary (GU) function was assessed with International Prostate Symptom Scores. Treatment-related toxicities were graded using CTCAE v 4.03. ResultsMedian follow-up was 26.5 months (range, 1–53.6 months); median age at EBRT salvage was 67 years (range, 61–81 years). Salvage EBRT included the whole pelvis in 8 patients. Two patients were treated with 3D-CRT; 9 underwent IMRT. Five patients (45%) received androgen deprivation therapy concurrent with salvage EBRT as part of long- or short-course hormone therapy. The median prostate dose was 70.2 Gy (range, 64.8–75.6 Gy). Actuarial 3-year overall and biochemical failure–free survival were 77% and 69%, respectively. Five patients (45%) had worsening GU symptoms, and 9 (82%) experienced a decline in erectile function. One patient experienced acute grade 2 GU toxicity. Four patients (36%) experienced late grade ≥2 GI/GU toxicities, including 2 who experienced grade 3 toxicities (rectourethral fistula/incontinence, bladder outlet obstruction). No grade 4/5 toxicities were noted. ConclusionsOur data suggest that salvage EBRT can provide similar disease control and treatment-related toxicity to more established salvage therapies. This approach warrants further investigation on a larger scale.

Design, Implementation, and Response Rates From an Online Patient Survey to Assess Genitourinary Symptoms and Related Health Care Experiences of Postmenopausal Women

Design, Implementation, and Response Rates From an Online Patient Survey to Assess Genitourinary Symptoms and Related Health Care Experiences of Postmenopausal Women

Trends in Pharmacotherapy for Bladder Dysfunction Among Children in the United States, 2000 to 2013.

Bladder-related issues such as nocturnal enuresis and incontinence have long been a part of general pediatric practice. Increasingly, clinicians are prescribing medications directed at a variety of types of bladder dysfunction, but no prior population-based data exist. We used MarketScan health care claims data on 32 074 638 insured children to estimate utilization patterns by age, sex, year, and geographic region in the United States from 2000 to 2013, and to assess related diagnosis codes. Approximately 1 in 500 children filled an antimuscarinic prescription. The most common prescriptions were for oxybutynin (78%) and tolterodine (17%). Rates were highest at ages 6 to 10 years (65/100 000 person-months), 31% higher for girls versus boys, peaked in 2011 (44/100 000 person-months), and were highest in the Midwest (59/100 000 person-months). Seventy-three percent of children with prescriptions had diagnosis codes for genitourinary symptoms, and 13% had codes for congenital anomalies. Research is needed regarding the comparative effectiveness and safety of these drugs in children.

How social representations of sexually transmitted infections influence experiences of genito-urinary symptoms and care-seeking in Britain: mixed methods study protocol.

BackgroundSocial understandings of sexually transmitted infections and associated symptoms and care-seeking behaviour continue to lag behind advancements in biomedical diagnostics and treatment, perpetuating the burden of disease. There is a lack of research linking perceptions, experiences and care-seeking for sexual health issues, especially research conducted outside of medical settings. We aim to explore lay perceptions of STIs and how these influence experiences of genito-urinary symptoms and associated care-seeking behaviour, in women and men in Britain.Methods and designThis study adopts a participant-selection variant of the explanatory sequential mixed methods design to incorporate quantitative and qualitative strands. We use data from Britain’s third National Survey of Sexual Attitudes and Lifestyles (n = 15,162) to analyse national patterns of symptom experience and care-seeking, and to identify a purposive qualitative sample. Semi-structured interviews (n = 27) following up with survey participants include a novel flash card activity providing qualitative data about infection perceptions, symptom experiences and decisions about healthcare. Quantitative and qualitative data are analysed separately using complex survey analyses and principles of Interpretative Phenomenological Analysis respectively. Data are then integrated in a subsequent phase of analysis using matrices to compare, contrast and identify silences from each method.DiscussionThis is an ongoing mixed methods study collecting, analysing and synthesising linked data from a national survey and follow-up semi-structured interviews. It adds explanatory potential to existing national survey data and is likely to inform future surveys about sexual health. Given the current uncertainty around service provision in Britain, this study provides timely data about symptom experiences and care-seeking behaviour which may inform future commissioning of sexual healthcare.

Nocturia in women.

Nocturia in women is a notable health concern, associated with significant morbidity and decreases in health-related quality of life. It is implicated in daytime somnolence and poor sleep quality, and has been found to negatively impact household activities, work, exercise, and sexual activity. This review is intended to relay new information regarding the prevalence, cause, risk factors, ramifications, and treatment options for nocturia in women as it gains traction as a clinical entity in and of itself. New literature exposes the prevalence and burden of nocturia among young, healthy nulliparous women; reveals its presence in women without daytime symptoms; suggests its relationship with abnormal bowel function; and supports its association with obesity, cardiac burden and poor sleep. The link between nocturia and menopause has been challenged, and recent nomenclature describing the genitourinary symptoms of menopause excludes it from the list. Desmopressin and tamsulosin trials in women have demonstrated safety and efficacy in limiting nocturia frequency and severity, as well as in improving sleep parameters. Nocturia is an impactful health issue at risk of being missed, especially in younger female patients. Open dialogue, purposeful questioning, and screening surveys can help elicit this symptom in women who are embarrassed or who accredit it to normal aging and therefore do not seek medical attention. In light of a growing geriatric population, nocturia is a clinical entity of increasing importance as it can be a clue to underlying systemic disorder or it can be an isolated symptom with significant clinical implications if left unaddressed.

P067 Why don’t people with genito-urinary symptoms go to sexual health clinics? A mixed methods study about meanings of symptoms and care-seeking using the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Background/introduction There are both individual and public health benefits in people responding to genito-urinary symptoms effectively. Sexual health clinics are best equipped for managing symptoms but not everyone with symptoms chooses to attend. Aim(s)/objectives To examine the prevalence and meanings of genito-urinary symptoms and the impact on non-attendance at sexual health clinics among people in Britain. Methods An explanatory sequential mixed methods study design was used to estimate symptom and clinic non-attendance prevalences using data from 8,947 sexually-experienced women and men aged 16–44 years who participated in Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). We conducted follow-up semi-structured interviews with Natsal-3 participants (n = 27) who reported current or recent symptoms and had never attended a clinic, in order to explore STI perceptions, symptom meanings and care-seeking behaviour. Results Prevalence of experiencing symptom(s) in the last month was 21.6% (95% CI 20.4–22.9%) among women and 5.6% (95% CI 4.9–6.6%) among men, of whom 86.3% (95% CI 84.2–88.1) reported not having attended a sexual health clinic in the past year. Bodily changes were not always viewed as symptoms and perceived potential causes were diverse, causing strong emotional responses. Individuals normalised, concealed and/or distanced their experiences from STIs. GPs were the preferred service provider although not all participants perceived a need for care. Discussion/conclusion Symptoms are more commonly reported by women although both women and men may benefit from interventions targeting symptom normalisation and concealment. Good links between services will facilitate efficient and appropriate care-seeking and service delivery.

P146 Diagnosing gonorrhoea – how do doctors and nurses compare? An audit of gonorrhoea management in a large provincial NHS Trust

Background/introduction Although gonorrhoea rates are rising, incidence of urethral and cervical infection remain low in comparison to historic data. There is therefore concern that expertise in microscopic diagnosis of gonorrhoea may be falling. Additionally, in light of emerging resistance of gonorrhoea to extended-spectrum cephalosporins, multiple guidelines highlight the importance of taking cultures from NAAT positive sites prior to antibiotic treatment. Aim(s)/objectives To evaluate the sensitivity of urethral microscopy performed by doctors/nurses and the frequency with which cultures are taken from all NAAT positive sites prior to treatment. Methods A retrospective case note review of 100 patients with a gonorrhoea diagnosis and all gonorrhoea contacts in the same time period. Results 16 men with genitourinary symptoms had positive urethral cultures on initial visit. 16/16 (100%) had positive microscopy. 32 men with genitourinary symptoms had a positive urethral/urine NAAT, of which 30 had microscopy. In 25/30 (83%), microscopy was positive. When performed by doctors, this was 7/8 (88%), and by nurses was 18/22 (82%)(p = 0.46). 64 patients with a positive NAAT were consulted by exclusively doctors or nurses before treatment. 11/15 (73%) of doctors’ patients and 30/49 (61%) of nurses’ patients had cultures taken from all NAAT positive sites before treatment (p = 0.12). Discussion/conclusion Microscopy in men with genitourinary symptoms remains sensitive in comparison with culture. However, there may be a case for a new auditable standard comparing microscopy with NAATs. Doctors and nurses are inconsistent in taking cultures from all NAAT positive sites prior to treatment and training in both groups should be addressed.

Update on Zika Virus Infections

Zika virus is a mosquito-borne flavivirus that is the focus of an ongoing pandemic and public health emergency (1, 2). Previously limited to sporadic cases in Africa and Asia, the emergence of Zika virus in Brazil in 2015 heralded its rapid spread throughout the Americas. As the Zika virus has widely spread in less than a year, its status has changed from a mild medical curiosity to a disease with severe public health implications (3). Serosurveillance studies in humans suggest that Zika is widespread throughout Africa, Asia, and Oceania. However, these studies may overestimate the virus’s true prevalence, given the serologic overlap between Zika virus and related flaviviruses, such as dengue virus (DENV) and west Nile virus (WNV) (4-6). Historically, symptomatic Zika virus infections were limited to sporadic cases or small clusters of patients (7). Zika was first reported in May 2015 in continental South America, in Brazil, where 440000 1300000 persons were subsequently infected through February 16, 2016. Furthermore, 29 other countries in the Americas have reported autochthonous Zika virus transmission, including Puerto Rico and the U.S. Virgin Islands (8). Zika virus, like other flaviviruses, is transmitted by mosquitoes, primarily of the Aedes (Stegomyia) genus (911). Mosquito acquisition of the virus likely occurs during a blood meal; after uptake, the virus replicates and is transmitted to a reservoir animal at the next blood meal (12). Other non-vector modes of Zika virus transmission are congenital, perinatal, and sexual. Possible transmission via blood transfusion, animal bite, and laboratory exposure has been described; however, confounding by contemporaneous vector-borne transmission in these instances cannot be excluded (13-18). In humans, the incubation period from mosquito bite to symptoms is 3 12 days. Infection is likely asymptomatic in 80% of cases. All ages are susceptible (4 days to 76 years), with a slight preponderance in females. When symptoms occur, they are typically mild, self-limiting, and nonspecific, similar to other arbovirus infections. Commonly reported symptoms include rash, fever, arthralgia, myalgia, fatigue, headache, and conjunctivitis. Rash is a prominent feature and is maculopapular and pruritic in most cases; it begins proximally and spreads to the extremities, with spontaneous resolution within 1 4 days of onset. The symptoms resolve within 2 weeks, and accounts of longer persistence are rare (7, 12, 19). More severe clinical sequelae have increasingly been associated with Zika virus. During the ongoing outbreak in Brazil, reports of infants born with microcephaly have markedly increased. Also, severe neurologic sequelae have also been described in adults, including meningitis and meningoencephalitis (20). Non-neurologic sequelae include transient hearing loss, hypotension, and genitourinary symptoms (21-23). Zika virus disease is usually relatively mild and requires no specific treatment. People sick with this virus should get plenty of rest, drink sufficient fluids, and treat pain and fever with common medicines. If symptoms worsen, they should seek medical care and advice. There is currently no vaccine available (24). Mosquitoes and their breeding sites pose a significant risk factor for Zika virus infection. Prevention and control relies on reducing mosquitoes through source reduction, and reducing contact between mosquitoes and humans (25). This can be done by using insect repellent regularly; wearing clothes (preferably light-colored) that cover as much of the body as possible; installing physical barriers in buildings, such as window screens, closed doors, and windows; and if needed, the use of additional personal protection, such as sleeping under mosquito nets during the day. It is extremely important to regularly empty, clean, or cover containers that can store water, such as buckets, drums, and pots. Other mosquito-breeding sites should be cleaned or removed, including flower pots, used tires, and roof gutters. Communities must support the efforts of the local government to reduce the density of mosquitoes in

MP25-20 ASSOCIATION BETWEEN GENITOURINARY DISEASES AND DEPRESSIVE SYMPTOMS IN THE 2005-2012 NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

INTRODUCTION AND OBJECTIVES: Genitourinary diseases may increase the risk of depression. However, the magnitudes of these associations are unclear. To clarify the available evidence, we analyzed self-reported urologicand depressive-symptom questionnaire data from the 2005-2012 National Health and Nutrition Examination Survey (NHANES). METHODS: We analyzed the responses of 2005-2012 NHANES participants who completed surveys on kidney failure, urolithiasis, and lower urinary tract symptoms (e.g., frequency, leakage, and nocturia) and depression (assessed using the nine-item Patient Health Questionnaire, or PHQ-9). Urologic-symptom variables were examined in sample-weighted linear regression models for associations with depressive symptoms. Models were adjusted for potential confounders including age, sex, body-mass index, alcohol intake, tobacco use, income-to-poverty ratio, physical activity, and the presence of medical comorbidities. Statistical significance was defined as a twotailed P < 0.05. RESULTS: Survey data from 5,009 men and 5,278 women with a median age of 49 years (range: 20 to 85) were analyzed. On multivariate analysis, self-report of urine leakage at rest, during physical activity, before reaching the toilet, at night, or at any time was significantly associated with increased depressive symptoms (quantitative results are shown in the Figure). Self-report of weak or failing kidneys was similarly associated with increased depressive symptoms. Urolithiasis was not significantly associated with depressive symptoms. CONCLUSIONS: In this analysis, potentially clinically important independent associations between genitourinary and depressive symptoms were identified. Further studies are needed to determine the importance of these results with regard to screening for or treating depression in the urology clinic.

204 Randomized controlled study of the efficacy and safety of continuous saline bladder irrigation after transurethral resection for the treatment of non-muscle invasive bladder cancer

INTRODUCTION AND OBJECTIVES: Genitourinary diseases may increase the risk of depression. However, the magnitudes of these associations are unclear. To clarify the available evidence, we analyzed self-reported urologicand depressive-symptom questionnaire data from the 2005-2012 National Health and Nutrition Examination Survey (NHANES). METHODS: We analyzed the responses of 2005-2012 NHANES participants who completed surveys on kidney failure, urolithiasis, and lower urinary tract symptoms (e.g., frequency, leakage, and nocturia) and depression (assessed using the nine-item Patient Health Questionnaire, or PHQ-9). Urologic-symptom variables were examined in sample-weighted linear regression models for associations with depressive symptoms. Models were adjusted for potential confounders including age, sex, body-mass index, alcohol intake, tobacco use, income-to-poverty ratio, physical activity, and the presence of medical comorbidities. Statistical significance was defined as a twotailed P < 0.05. RESULTS: Survey data from 5,009 men and 5,278 women with a median age of 49 years (range: 20 to 85) were analyzed. On multivariate analysis, self-report of urine leakage at rest, during physical activity, before reaching the toilet, at night, or at any time was significantly associated with increased depressive symptoms (quantitative results are shown in the Figure). Self-report of weak or failing kidneys was similarly associated with increased depressive symptoms. Urolithiasis was not significantly associated with depressive symptoms. CONCLUSIONS: In this analysis, potentially clinically important independent associations between genitourinary and depressive symptoms were identified. Further studies are needed to determine the importance of these results with regard to screening for or treating depression in the urology clinic.

Vaginal estradiol use and the risk for cardiovascular mortality.

Does the use of post-menopausal vaginal estradiol (VE) affect the mortality risk for coronary heart disease (CHD) and stroke. The use of VE reduces the risk for cardiovascular mortality. A growing number of women use VE for post-menopausal genitourinary symptoms. Although this therapy is intended to have only local effects, estrogen is absorbed into the blood circulation and thus VE use may also have systemic effects. We studied a nationwide cohort in Finland 1994-2009 during which post-menopausal women (n = 195 756) initiated the use of VE (age [mean ± SD] 65.7 ± 10.9 years). Follow-up data gathered 1.4 million women-years and we assessed the mortality risk due to CHD (n= 9656) or stroke (n = 4294). The mortality risk in VE users was compared with that in the age-matched background population (standardized mortality ratio; [SMR]; 95% confidence interval) and related to various durations of exposure to VE (1 to ≤3, >3 to ≤5, >5 to ≤10 and >10 years). The use of VE was accompanied by decreases in the risk for CHD and stroke death. The risk reduction for CHD death was highest for >3 to ≤5 years exposure (SMR 0.64; 0.57-0.70) and for stroke for >5 to ≤10 years exposure (SMR 0.64; 0.57-0.72). The risk reductions for both CHD and stroke mortality were detected in all age groups with the highest risk reduction being in women aged 50-59 years (SMR 0.43; 0.19-0.88 and SMR 0.21; 0.06-0.58, respectively). Our series lack a placebo arm and thus, may harbor a healthy woman bias. Moreover, data on clinical variables such as weight, smoking, blood pressure and family background were unobtainable for this study. Women using both VE and systemic hormone therapy (HT) were included in the comparator background population. This should not cause any significant error because the proportion of women using VE or other HT was modest (<10% in age-matched population) and because the use of systemic HT also reduces death risks in the same population. Our data cannot be directly applied for local regimens containing conjugated equine estrogens, because they are absorbed differently and may show effects that differ from those of estradiol. In 1000 women using VE for up to 10 years, a maximum of 24 fewer CHD deaths and 18 fewer stroke deaths is likely to occur. This work was supported by unrestricted grants from the Päivikki and Sakari Sohlberg Foundation, the Emil Aaltonen Foundation, the Finnish Medical Foundation, Finska Läkaresällskapet, the Orion Farmos Research Foundation, the Paavo Nurmi Foundation and a special governmental grant for health sciences research. The funding sources had no role in the study design, data handling or manuscript preparation. EPID Research is a company that performs financially supported studies for several pharmaceutical companies. Dr Korhonen, Dr Hoti and MSc Vattulainen, employed by Epid Research, report financial activities from several other pharmaceutical companies outside the submitted work. Dr Mikkola has been a speaker and/or received consulting fees from Mylan and Novo Nordisk. Dr Tuomikoski has been a speaker and/or received consulting fees from Orion and Mylan. The remaining authors report no conflict of interest.

Urinary bladder dose–response relationships for patient-reported genitourinary morbidity domains following prostate cancer radiotherapy

Background and purposeRadiotherapy (RT) induced genitourinary (GU) morbidity is typically assessed by physicians as single symptoms or aggregated scores including symptoms from various domains. Here we apply a method to group patient-reported GU symptoms after RT for localized prostate cancer based on their interplay, and study how these relate to urinary bladder dose. Materials and methodsData were taken from two Scandinavian studies (N=207/276) including men treated with external-beam RT (EBRT) to 78/70Gy (2Gy/fraction; median time-to-follow-up: 3.6–6.4y). Within and across cohorts, bladder dose–volume parameters were tested as predictors for GU symptom domains identified from two study-specific questionnaires (35 questions on frequency, incontinence, obstruction, pain, urgency, and sensory symptoms) using univariate and multivariate logistic regression analysis (MVA) with 10-fold cross-validation. Performance was evaluated using Area Under the Receiver Operating Characteristic Curve (Az). ResultsFor the identified Incontinence (2–5 symptoms), Obstruction (3–5 symptoms), and Urgency (2–7 symptoms) domains, MVA demonstrated that bladder doses close to the prescription doses were the strongest predictors for Obstruction (Az: 0.53–0.57) and Urgency (Az: 0.60). For Obstruction, performance increased for the across cohort analysis (Az: 0.61–0.64). ConclusionsOur identified patient-reported GU symptom domains suggest that high urinary bladder doses, and increased focus on both obstruction and urgency is likely to further add to the understanding of GU tract RT responses.

Clinical Update on Spondyloarthritis

The spondyloarthritides encompass various clinical manifestations. The hallmark of the spondyloarthropathies is inflammatory axial and sacroiliac (buttock) pain. Associated findings include peripheral arthritis, uveitis, conjunctivitis, enthesitis, and psoriasis. Human leukocyte antigen (HLA) B27 is positive in a majority of patients. Radiographic abnormalities appear first on vertebral column/sacroiliac magnetic resonance imaging (MRI) and many years later on radiography, which makes the diagnosis challenging. Of course, rheumatoid factor is negative – hence the term seronegative arthritis. Other clinical clues that help identify this disease’s spectrum are a family history of ankylosing spondylitis (AS), psoriasis, or inflammatory bowel disease (IBD); intestinal or genitourinary symptoms; or the presence of psoriasis. All this heterogeneity makes an early diagnosis difficult.

ROLE OF AYURVEDIC DRUGS IN TREATING GERIATRIC DISORDERS AND IN IMPROVING THE QUALITY OF LIFE - A DEMONSTRATIVE PROJECT

Present study is a demonstrative trial taken up with the aim of establishing the safety and efficacy of compound Ayurvedic drugs in geriatric people, who are institutionalised at old age home. Patients recruited under this study were suffering with minor to moderate ailments and given disease specific Ayurvedic medicines along with them one Rasayana drug like Ashvagandha/ Triphala/ Yashtimadhu/ Amalaki. Mini mental status examination (MMSE) and Hamilton Anxiety Rating Scale (HARS) tests were applied initially and after completion of six months to evaluate the efficacy of Ayurvedic drugs in treating the Geriatric problems and enhancing the quality of life on total 30 subjects recruited for this study. All the patients were undergone blood tests before and after treatment for their kidney and liver function tests.On analysis of MMSE, it is found that total 16 (53.34) cases were showed improvement; in the HARS – Psychic level, majority of cases showed improvement in all the parameters viz., anxiety, tension, fear, insomnia, intellectual and depression; similarly in the HARS-somatic level, showed improvement in all the parameters - General Somatic (muscular), General Somatic (sensory), cardio-vascular, respiratory, gastro-intestinal, genito-urinary and autonomic system symptoms. Blood markers of liver and kidney function were within normal limits in all patients before and after treatment. This indicates that the used Ayurvedic drugs are safe even in the geriatric people.Â

Clinical evaluation and urodynamic study observation in post-menopausal female: a comparative study

Background: Menopause is an irreversible and age related phenomenon and serves as an objective sign of reproductive senescence. Atrophic changes within the urogenital tract may occur due to estrogen deficiency and is associated with genitourinary symptoms. Methods: A total of 66 women who attained natural and surgical menopause with more than twelve months with urogenital symptoms were selected for study. Results: Age of patients selected for study was between 35-70 years. Majority of the patients 52/66 (78.7%) were presented after minimum 5 yrs of menopause. Among genital symptoms vaginal discharge was significantly higher (p 0.05). Among urinary symptoms frequency was the most common symptom in both the groups, 15 (44.12%) in natural menopause and 22 (68.75%) in surgical menopause, more prevalent in surgical group. Urgency was seen in 38.23% in natural menopause and 56.25% in surgical menopause. Incontinence was present in 47.05% in natural menopause and 62.51% in surgical menopause. Among incontinence stress incontinence was most common in the groups, 20.59% in natural group and 37.5 % in surgical group, statistically significant in surgical group. Mixed incontinence was observed in 5.58% in natural menopause; statistically significant in surgical group. Prevalence of urge incontinence was observed more in natural menopause 20.59% and 3.12 % in surgical menopause. There was no statistically significant difference in uroflowmetry parameters between both the groups. In cystometry parameters, volume at first bladder sensation was significantly less in patients with urgency and urge incontinence in both groups. Maximum bladder capacity was less in detrusor overactivity in both the groups. Compliance was poor in patient with urge incontinence in both the groups. Conclusions: Hypoestrogenism could be an etiological factor in urogenital dysfunction in postmenopausal women with spontaneous menopause and surgical menopause.