History Of Urinary Tract Infection Research Articles

The impact of Technetium-99m dimercapto-succinic acid scintigraphy on DNA damage and oxidative stress in children.

Technetium-99m-dimercapto succinic acid (Tc-99m DMSA) scintigraphy is a commonly used imaging modality in children with urological abnormalities. The radiopharmaceuticals, which have the effects of ionising radiation, are used in this method. This study aimed to investigate the impact of the Tc-99m DMSA scan on renal oxidative stress and mononuclear leukocyte (MNL) DNA damage. Children, who were followed up by paediatric nephrology at Bezmialem Vakif University and underwent Tc-99m DMSA scintigraphy between April 2015 and January 2016 with the indication of detection of renal scars, were included in this study. The exclusion criteria were nephrolithiasis, history of premature birth and recent urinary tract infection 3months prior to scintigraphy or antibiotic use in the last 1month. 3mL heparinised blood samples were obtained just before, immediately after and 1week after the scintigraphy. MNL DNA damage, total antioxidant status (TAS) and total oxidant status (TOS) were measured in the blood samples. The oxidative stress index (OSI) was calculated. Spot urine samples were obtained from each patient before and within 3days after performing the scintigraphy. TAS/Creatinine (TAS/Cr), TOS/Creatinine (TOS/Cr) and N-acetyl-glucosaminidase/creatinine (NAG/Cr) levels were measured in the urine samples. Twenty-seven children were evaluated. The values between TAS, TOS and OSI levels in serum samples at baseline, immediately after and 1week after the scintigraphy (P=.105, P=.913, and P=.721, respectively) showed no statistically significant difference. The levels of TAS/Cr, TOS/Cr, NAG/Cr ratios and OSI, which were evaluated from urine samples before and within 3days after the scintigraphy scan were also similar (P=.391, P=.543, P=.819 and P=.179, respectively). The levels of DNA damage only increased following scintigraphy scan and decreased a week later (P<.05). The effect of Tc-99m DMSA scintigraphy is insufficient to create oxidative damage, but it can cause DNA damage via the direct impact of ionising radiation which can be repaired again in a short time.

Septic arthritis in the end-stage renal disease population

Septic arthritis is important to consider in any patient who presents with joint pain because it is a medical emergency with an 11% fatality rate. Diagnosis and treatment may improve...

A multidisciplinary approach to the preterm birth

Introduction. Rate of factors affecting preterm birth development has not been fully elucidated. The assessment was carried out by identifying 1-2 causes used to build up prognosis.Aim: to identify most relevant risk factors for preterm birth and assess their impact on pregnancy.Materials and Methods. The prospective comparative study was conducted that included group 1 - 36 women with term pregnancy, group 2 - 35 with preterm labor. Establishment of the menstrual cycle has been studied by assessing reproductive, somatic history, and course of current pregnancy.Results. The postpartum women from group 2 were characterized by older age (30.42 ± 6.19 years; p = 0.038). The groups differed by the age of menarche: in group 2, its onset was recorded earlier (11.31 ± 0.79 years), showing shorter duration of menstruation (4.25 ± 1.26 days) as well as menstrual cycle (27.71 ± 3.46 days). Infections in puberty were substantially more frequent in postpartum women from group 2: group 2 vs. group 1 - in 21 vs. 8 postpartum women (p &lt; 0.001); a history of urinary tract infections was also more common in group 2 (in 17 puerperas; p = 0.003), that is also typical for cases resulting in preterm pregnancy. The causative agent of bacterial vaginosis in group 2 was more often presented by Atopobium vaginae (in 17 puerperas; p = 0.0001), with Gardnerella vaginalis found less frequently (in 13 puerperas; p = 0.024), which is important to know for selecting proper therapy. During full-term pregnancy, the Lactobacillus crispatus strain, that determines vaginal health, was excreted significantly more often (in 29 puerperas; p = 0.009). Anemia affecting the antenatal fetal development and the course of labor was significantly more frequent in group 2 (in 22 puerperas; p &lt; 0.001).Conclusion. While planning pregnancy, it is necessary to take into account the age, menstrual cycle features, history of former infections, vaginal microbiota features, as well as conduct proper therapy and prevention in pregravid period.

MP29-01 PREDICTORS OF SEPSIS OR ACUTE PYELONEPHRITIS DUE TO OBSTRUCTIVE UROLITHIASIS: A 15-YEAR UNITED STATES COHORT STUDY

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II (MP29)1 Sep 2021MP29-01 PREDICTORS OF SEPSIS OR ACUTE PYELONEPHRITIS DUE TO OBSTRUCTIVE UROLITHIASIS: A 15-YEAR UNITED STATES COHORT STUDY Koo Han Yoo, Hyuk Jin Cho, Phil Hyun Song, Jin Kyu Oh, Sang Youn Kim, Wuran Wei, Wansuk Kim, Sinyeong Lee, Jianlin Huang, Shufeng Li, Kyle Spradling, Francesco Del Giudice, Simon Conti, and Benjamin Chung Koo Han YooKoo Han Yoo More articles by this author , Hyuk Jin ChoHyuk Jin Cho More articles by this author , Phil Hyun SongPhil Hyun Song More articles by this author , Jin Kyu OhJin Kyu Oh More articles by this author , Sang Youn KimSang Youn Kim More articles by this author , Wuran WeiWuran Wei More articles by this author , Wansuk KimWansuk Kim More articles by this author , Sinyeong LeeSinyeong Lee More articles by this author , Jianlin HuangJianlin Huang More articles by this author , Shufeng LiShufeng Li More articles by this author , Kyle SpradlingKyle Spradling More articles by this author , Francesco Del GiudiceFrancesco Del Giudice More articles by this author , Simon ContiSimon Conti More articles by this author , and Benjamin ChungBenjamin Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002026.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sepsis or acute pyelonephritis (APN) caused by obstructing ureteral calculi can have serious consequences, resulting in inpatient hospitalization or intensive care unit admission. This study aimed to identify the characteristics of patients with sepsis or APN caused by ureteral calculi and to analyze risk factors in its causation. METHODS: We included patients with sepsis or APN caused by ureteral calculi who received treatment in the United States from January 2003 to December 2017 using the Optum® de-identified Clinformatics© Datamart. Demographic factors and risk factors for the receipt of sepsis or APN were subsequently analyzed for statistical significance. RESULTS: A total of 467,502 patients received treatment for urinary stones were analyzed and of these, 25,747 (5.50%) were diagnosed with sepsis or APN. Age-matched multivariate analysis revealed that history of urinary tract infection (OR 11.21, 95% CI 10.58-11.88, p <0.001) and female gender (OR 2.74, 95% CI 2.63-2.85, p <0.001) were significantly related to an increased risk of sepsis or APN. Also, the presence of comorbid conditions, especially 3 or more (OR 2.95 (2.78-3.14), p <0.001) was also a significant predictor of sepsis or APN. Conversely, a previous past medical history of urolithiasis (OR 0.89, 95% CI 0.86-0.93, p <0.0001) and cancer (OR 0.93, 95% CI 0.89-0.97, p=0.0002) were associated with decreased risk of sepsis or APN. CONCLUSIONS: A history of urinary tract infection, female gender, and multiple coexisting comorbid conditions are significant risk factors for sepsis or APN in patients with ureteral calculi. These patients should be strongly advised to undergo active treatment to reduce the incidence of life-threatening infections. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e490-e490 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Koo Han Yoo More articles by this author Hyuk Jin Cho More articles by this author Phil Hyun Song More articles by this author Jin Kyu Oh More articles by this author Sang Youn Kim More articles by this author Wuran Wei More articles by this author Wansuk Kim More articles by this author Sinyeong Lee More articles by this author Jianlin Huang More articles by this author Shufeng Li More articles by this author Kyle Spradling More articles by this author Francesco Del Giudice More articles by this author Simon Conti More articles by this author Benjamin Chung More articles by this author Expand All Advertisement Loading ...

MP25-16 IMPACT OF DURATION OF ANTIBIOTIC PROPHYLAXIS ON UTI RATE AFTER ONABOTULINUMTOXINA INJECTION

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I (MP25)1 Sep 2021MP25-16 IMPACT OF DURATION OF ANTIBIOTIC PROPHYLAXIS ON UTI RATE AFTER ONABOTULINUMTOXINA INJECTION Sarah Martin, Jacqueline Zillioux, Neil Kocher, Raymond Rackley, Sandip Vasavada, Howard Goldman, Katie Propst, Eiftu Haile, and Emily Slopnick Sarah MartinSarah Martin More articles by this author , Jacqueline ZilliouxJacqueline Zillioux More articles by this author , Neil KocherNeil Kocher More articles by this author , Raymond RackleyRaymond Rackley More articles by this author , Sandip VasavadaSandip Vasavada More articles by this author , Howard GoldmanHoward Goldman More articles by this author , Katie PropstKatie Propst More articles by this author , Eiftu HaileEiftu Haile More articles by this author , and Emily SlopnickEmily Slopnick More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002022.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are currently no specific guidelines on antibiotic prophylaxis for intravesical OnabotulinumtoxinA (BTX) injection, despite high risk of post-procedural urinary tract infection (UTI). Our objective was to assess the impact of duration of antibiotic prophylaxis on rate of UTI within 30 days of BTX injection. METHODS: A retrospective chart review was performed of patients who received office BTX injection from 2014-2020 with FPMRS providers at a single academic institution. UTI rates within 30 days of BTX were compared between three prophylaxis regimens: no antibiotic, a single dose, or a multiple day course of any antibiotic. UTI was defined as new lower urinary tract symptoms treated either empirically or associated with a positive urine culture. Patients on daily antibiotic prophylaxis for recurrent UTI were excluded. Association of UTI with units of BTX, BMI, history of diabetes, immunosuppresion, neurogenic bladder or recurrent UTI and incidence of new post-procedure urinary retention were also investigated. Statistical analysis was performed with univariate and subsequent multivariable logistic regression analysis to assess for possible confounding factors. RESULTS: A total of 180 patients and 560 cycles of BTX injections were included: 173 (96%) were women with mean age 62.9 years (range 20-95; SD 12.6). The majority received 100U (65%) for a non-neurogenic diagnosis (67%). Overall rates of UTI and urinary retention within 30 days were 11% and 6%, respectively. No antibiotic prophylaxis was given to 79 (14%) patients, 343 (61%) received a single dose, and 138 (25%) received a multiple day regimen (3-7 days). On univariate analysis, UTI incidence was lower with administration of any antibiotic prophylaxis as compared to none: single dose 7.6% vs. 25.3% (OR 0.24, p<0.001), multiple dose 11.0% vs. 25.3% (OR 0.36, p=0.007). There was no difference in UTI rates between single and multiple dose antibiotic regimens (p=0.233). On multivariable logistic regression, use of any antibiotic prophylaxis was associated with a lower incidence of UTI (single OR 0.32, p=0.002; multiple OR 0.42, p=0.042), with no difference between single and multiple dose regimens (p=0.068). History of recurrent UTI (OR 2.3, p=0.024) and de novo post-procedure retention (OR 3.9, p=0.002) were predictors of UTI. CONCLUSIONS: Use of antibiotic prophylaxis for office intravesical BTX injection is associated with a significantly lower incidence of UTI compared to no antibiotic. Importantly, a multiple day regimen was not more effective than a single dose of antibiotics in preventing UTI. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e459-e460 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Martin More articles by this author Jacqueline Zillioux More articles by this author Neil Kocher More articles by this author Raymond Rackley More articles by this author Sandip Vasavada More articles by this author Howard Goldman More articles by this author Katie Propst More articles by this author Eiftu Haile More articles by this author Emily Slopnick More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-09 ROLE OF NON-OPERATIVE MANAGEMENT OF URETEROCELES: SHOULD WE PUNCTURE ALL URETEROCELES?

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-09 ROLE OF NON-OPERATIVE MANAGEMENT OF URETEROCELES: SHOULD WE PUNCTURE ALL URETEROCELES? Aznive Aghababian, Sameer Mittal, Sahar Eftekharzadeh, John Weaver, Katherine Fischer, Christopher Long, Dana Weiss, Jason Van Batavia, Mark Zaontz, Thomas Kolon, Stephen Zderic, Douglas Canning, Aseem Shukla, and Arun Srinivasan Aznive AghababianAznive Aghababian More articles by this author , Sameer MittalSameer Mittal More articles by this author , Sahar EftekharzadehSahar Eftekharzadeh More articles by this author , John WeaverJohn Weaver More articles by this author , Katherine FischerKatherine Fischer More articles by this author , Christopher LongChristopher Long More articles by this author , Dana WeissDana Weiss More articles by this author , Jason Van BataviaJason Van Batavia More articles by this author , Mark ZaontzMark Zaontz More articles by this author , Thomas KolonThomas Kolon More articles by this author , Stephen ZdericStephen Zderic More articles by this author , Douglas CanningDouglas Canning More articles by this author , Aseem ShuklaAseem Shukla More articles by this author , and Arun SrinivasanArun Srinivasan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal management for ureteroceles has long been under debate, due to the anatomic variability and severity of this entity. Treatment strategies range from upper pole heminephrectomy or major bladder reconstruction, to isolated endoscopic incision. We hypothesize that a carefully selected group of ureteroceles can be successfully managed without surgical intervention. METHODS: We retrospectively reviewed medical records of all patients with a diagnosis of ureterocele who were managed at our institution from 2010-2019. Patients were categorized into two groups: non-surgical management and surgical management. Non-surgical management included those who had at least 6-month follow-up with no interventions including ureterocele puncture. We analyzed baseline demographics, clinical presentation, imaging details, history of urinary tract infection (UTI), and if any procedures were performed during the follow-up period. RESULTS: We identified 240 ureteroceles in 231 patients: 56 (23%) were managed without immediate puncture and 184 (77%) surgically. Patients who underwent non-puncture management were more likely to have an intravesical ureterocele, ipsilateral multi-cystic dysplastic kidney, and were unlikely to have hydronephrosis and/or reflux on the ipsilateral side. Of 56 patients in the non-incision cohort, 6 (10%) required surgery after a median observation of 2.5 years (IQR 2.1-4.5), with 4 ureteroceles associated with a duplex system (3 intravesical and 1 ectopic) and the other 2 associated with absent kidney and an ectopic insertion. The remaining 50 (90%) did not require any surgical intervention during a median follow-up of 2.4 years (IQR 0.9-4.6). In the cohort of 50 patients who did not undergo intervention, 35 (70%) were on antibiotic prophylaxis, and febrile UTIs occurred in 12 (24%) patients from this group. Multivariate regression analysis showed that intravesical ureteroceles were more likely to be successfully managed non-operatively than ectopic ureteroceles (OR: 103.6, 95% CI: 1.4–733.5). CONCLUSIONS: Children with ureteroceles without evidence of obstruction, and/or functional renal tissue can be successfully managed without puncturing the ureterocele. An intravesical ureterocele in these children may be a predictor of success. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e899-e899 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aznive Aghababian More articles by this author Sameer Mittal More articles by this author Sahar Eftekharzadeh More articles by this author John Weaver More articles by this author Katherine Fischer More articles by this author Christopher Long More articles by this author Dana Weiss More articles by this author Jason Van Batavia More articles by this author Mark Zaontz More articles by this author Thomas Kolon More articles by this author Stephen Zderic More articles by this author Douglas Canning More articles by this author Aseem Shukla More articles by this author Arun Srinivasan More articles by this author Expand All Advertisement PDF downloadLoading ...

MP44-06 ULTRASOUND CONTRAST-ENHANCED VOIDING CYSTOURETHROGRAM FOR DIAGNOSIS OF VESICOURETERAL REFLUX: SINGLE-INSTITUTION EXPERIENCE

You have accessJournal of UrologyPediatric Urology II (MP44)1 Sep 2021MP44-06 ULTRASOUND CONTRAST-ENHANCED VOIDING CYSTOURETHROGRAM FOR DIAGNOSIS OF VESICOURETERAL REFLUX: SINGLE-INSTITUTION EXPERIENCE Thomas Williams, Lane Palmer, John Amodio, and Jeffrey Palmer Thomas WilliamsThomas Williams More articles by this author , Lane PalmerLane Palmer More articles by this author , John AmodioJohn Amodio More articles by this author , and Jeffrey PalmerJeffrey Palmer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002065.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The current standard diagnostic method for vesicoureteral reflux (VUR) is fluoroscopic voiding cystography (VCUG). However, exposure to this inherent ionizing radiation may increase the risk of developing a malignancy in this vulnerable population. The development of stable and reproducible intravesical ultrasound contrast agents and techniques offer an opportunity to diagnose VUR without radiation exposure. This study highlights a large volume, single-institution’s experience of ultrasound contrast-enhanced VCUG and reported outcomes. METHODS: Retrospective chart review for 143 pediatric patients who underwent ultrasound contrast-enhanced VCUG at a single children’s hospital between 2018 and 2020. Technique involved several voiding and filling cycles with 1cc of Lumason® microbubbles, mixed with normal saline, and instilled via catheter gravity drip. Primary outcomes measured grade of VUR (International Reflux Grading System) as interpreted by a trained pediatric radiologist. Additionally, related anatomical findings, indications for exam, and clinical outcomes were reported. RESULTS: Mean age ranged from newborn to 14 years of age (18.7 ± 33.6 months, mean ± SD). The predominant indication for examination was prenatal hydronephrosis, 85 patients (59.4%) followed by history of urinary tract infection, 46 patients (32.2%). Overall, VUR was detected in 41 patients (28.7%) with total of 58 renal units. VUR was more commonly noted on the left side - 31 renal units (53.4%) but without difference in reflux grade (3.1 vs 3.0). Reflux grade breakdown was Grade I (0), Grade II (19), Grade III (23), Grade IV (9), and Grade V (7). There were no complications. CONCLUSIONS: Ultrasound contrast-enhanced VCUG is a safe and efficient alternative to the diagnosis of VUR without exposure to ionizing radiation. Future studies should continue to explore exam reproducibility and comparison between that of fluoroscopic VCUG. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e794-e795 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Williams More articles by this author Lane Palmer More articles by this author John Amodio More articles by this author Jeffrey Palmer More articles by this author Expand All Advertisement Loading ...

Risk Indicators for Urinary Tract Infections in Low Risk Pregnancy and the Subsequent Risk of Preterm Birth.

Symptomatic urinary tract infections are associated with preterm birth. However, data on risk indicators for urinary tract infections are limited and outdated. The research is a secondary analysis. The study was a prospective multicenter cohort study of low-risk pregnant women. Logistic regression was used to identify risk indicators for urinary tract infections. The incidence of urinary tract infections was 9.4%. Multivariate logistic regression showed that a history of recurrent urinary tract infections and the presence of asymptomatic bacteriuria in the present pregnancy were associated with urinary tract infections (resp. OR 3.14, 95%CI 1.40–7.02 and OR 1.96 95%CI 1.27–3.03). Women with a urinary tract infection were at increased risk of preterm birth compared to women without a urinary tract infection (12 vs. 5.1%; adjusted HR 2.5 95%CI 1.8–3.5). This increased risk was not found in women with the identified risk indicators (resp. 5.3% vs. 5.1%, adjusted HR 0.35 95%CI 0.00–420 and adjusted HR 1.5 95CI% 0.59–3.9). In conclusion, in low-risk pregnant women, risk indicators for urinary tract infections are: a history of recurrent urinary tract infections and the presence of asymptomatic bacteriuria. The risk of preterm birth is increased in women with a urinary tract infection in this pregnancy. However, women with recurrent urinary tract infections and asymptomatic bacteriuria this pregnancy appear not to be at increased risk of preterm birth.

Culture-positive urinary tract infection following micturating cystourethrogram in children

ObjectiveTo determine the incidence of culture-positive urinary tract infection (UTI) after micturating cystourethrogram (MCUG). We further wanted to identify risk factors for developing a culture-positive UTI following MCUG. MethodsA retrospective review of the available medical records of 500 paediatric patients who underwent MCUG in Perth, Western Australia was performed. ResultsSeven (1.4%) patients comprised of four females and three males developed a febrile, culture-positive UTI within 14 days following MCUG. Significant association was found for female patients, patients with neurogenic bladder, and patients with previous culture-positive UTI as developing a culture-positive UTI following MCUG. Multivariate logistic regression determined that patients were more likely to develop culture-positive UTI within 14 days following MCUG if they had a known history of UTI (odds ratio: 5.0, 95% confidence interval: 1.5–17.3, p=0.010) or had a neurogenic bladder (odds ratio: 4.2, 95% confidence interval: 1.0–17.9, p=0.049). ConclusionThe incidence of patients who developed a febrile, culture-positive UTI following MCUG was low at 1.4%. Statistically significant and independent associations for the development of culture positive UTI were found in patients with neurogenic bladder and patients with previous culture-positive UTI. Further prospective studies are necessary to determine necessity of prophylactic antibiotics for high-risk patients, e.g., patients with neurogenic bladder or previous culture-positive UTI.

This Month in Adult Urology

This Month in Adult Urology

Diagnosis and grading of vesicoureteral reflux on voiding cystourethrography images in children using a deep hybrid model

Background and objectiveVesicoureteral reflux is the leakage of urine from the bladder into the ureter. As a result, urinary tract infections and kidney scarring can occur in children. Voiding cystourethrography is the primary radiological imaging method used to diagnose vesicoureteral reflux in children with a history of recurrent urinary tract infection. Besides the diagnosis of reflux, it is graded with voiding cystourethrography. In this study, we aimed to diagnose and grade vesicoureteral reflux in Voiding cystourethrography images using hybrid CNN in deep learning methods. MethodsImages of pediatric patients diagnosed with VUR between 2016 and 2021 in our hospital (Firat University Hospital) were graded according to the international vesicoureteral reflux radiographic grading system. VCUG images of 236 normal and 992 with vesicoureteral reflux pediatric patients were available. A total of 6 classes were created as normal and graded 1-5 patients. ResultsIn this study, a hybrid-based mRMR (Minimum Redundancy Maximum Relevance) using CNN (Convolutional Neural Networks) model is developed for the diagnosis and grading of vesicoureteral reflux on voiding cystourethrography images. Googlenet, MobilenetV2, and Densenet201 models are used as a part of the hybrid architecture. The obtained features from these architectures are examined in concatenating process. Then, these features are classified in machine learning classifiers after optimizing with the mRMR method. Among the models used in the study, the highest accuracy value was obtained in the proposed model with an accuracy rate of 96.9%. ConclusionsIt shows that the hybrid model developed according to the findings of our study can be used in the diagnosis and grading of vesicoureteral reflux in voiding cystourethrography images.

Immunohistochemical Expression of Retinoblastoma Gene Product and p53 Protein in Transitional Cell Carcinoma of the Urinary Bladder and its Relationship to Different Clinicopathological Parameters

BACKGROUND: Carcinoma of urinary bladder is one of the most common malignancies worldwide and constitutes a major health problem. Multiple risk factors are associated with this tumor and its prognosis will depend on different clinicopathological parameters. Over expression of P53 protein and mutant Rb gene is associated with more aggressive clinical and histopathological features of the tumor such as advanced stage and higher grade. AIM: The immunohistochemical expression of Rb gene and P53 gene will be assessed through their protein products in transitional cell carcinoma (TCC) of the urinary bladder and then will be correlated with other well-known risk factors and prognostic parameters of bladder TCC, such as grading, tumor size, smoking, alcohol drinking, and family history. METHODS: Patients were recruited from the uro-surgical department/Surgical Subspecialties Teaching Hospital during the period from November 2020 through April 2021. In this study, patients enrolled were those suspected to have bladder carcinoma. The work up included a full history and clinical examination. Surgical samples were taken from the patients for histopathological evaluation; the study’s samples represented either endoscopic cup biopsy, transurethral resection of the tumor, or radical cystectomy. Sections obtained from these samples were stained with the conventional hematoxylin and eosin stain. Then, immunohistochemical staining for P53 and pRB was applied only for patients diagnosed with TCC. RESULTS: The differences between low-grade and high-grade tumors regarding pRb percentage score were statistically significant (p = 0.026), but were not significant regarding the intensity score (p = 0.094). There were significant correlations between tumor stage and both pRb intensity and percentage scores (p = 0.044 and 0.042, respectively). Differences between low-grade and high-grade tumors regarding p53 intensity score were significant (p = 0.022). The differences between low-grade and high-grade tumors regarding p53 percentage score were significant (p = 0.049). The differences between different tumor stages regarding p53 intensity score were significant (p = 0.018). The differences between different tumor stages regarding P53 percentage score were significant (p = 0.019). CONCLUSIONS: Tumor’s grade was found to be correlated with the tumor stage with no correlation with the age, gender, smoking, family history of TCC, history of urinary tract infection, bladder stones, nor the recurrence of the tumor. The pRb intensity and the percentage scores were correlated to each other and to tumor’s grade and stage, except for the pRb intensity which showed no correlation with the tumor’s grade. The P53 intensity and percentage scores were correlated to each other and also to tumor’s grade and stage, so that P53 is over-expressed in tumors with higher grade and stage.

Trombosit-Lenfosit Oranı ve Nötrofil-Lenfosit Oranı Böbrek Taşının Sertliğini Öngörür mü?

Objective: The Hounsfield unit (HU) is the most common value to assess the stone formation and a predictive factor for the management success. In this study, it was aimed to investigate the prediction of the hardness of the stone using systemic inflammatory response markers.Methods: 192 patients (61 female and 131 male) patients who underwent conventional percutaneous nephrolithotomy (PCNL) between 2015 and 2020 were reviewed retrospectively. Patients with malignancy and history of preoperative urinary tract infection were excluded from this study. Patients’ neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and HU of the kidney Stone, which was obtained from NCCT, were recorded to data.Results: The mean age was 47.2 ± 14.11 (11-82) years. The average HU value of the patients’ stones was 1135.47 ± 362.19 (348-2096). The location of the stones was grouped as pelvis (n:64, 33.3%), single calyx (n:14, 7.2%), two calyces (n:93, 48.4%) and staghorn (n:21, 10.9%). In subgroup analysis, when divided by stone location, a negative correlation was found between the HU and N/L ratio in the single calyceal stone group, and a positive correlation was found between the HU and N/L ratio for pelvis and staghorn stones. Among these correlations, only the positive correlation between the HU and N/L ratio in the pelvic stone group was statistically significant (r=0.318, p=0.03). Assuming an arbitrary cut-off value for HU below 1000, there was no significant correlation between NLR and HU (r=0.266, p=0.171). However, HU above 1000, there was a significant positive correlation between NLR and HU (r=0.145, p=0.045).Conclusion: The findings suggest that NLR could be used as a biomarker to choose appropriate management and be helpful to anticipate the hardness of kidney stones by predicting the HU value.

Recurrent Urinary Tract Infections Risk Factors in Patients with Primary Vesicoureteral Reflux

Background: Knowing the risk of recurrence of urinary tract infection (UTI) in vesicoureteral reflux (VUR) can assist clinicians to sort therapeutic decisions. The current study's aim was to assess the association of UTI in VUR. Additionally, UTI recurrence might be predicted by the risk score. Materials and Methods: This case-control study was carried out on 123 children at department of Paediatric, Saidu Group of Teaching Hospitals, Swat for the duration of one year from 1st July 2020 to 30thJune 2021. Out of 123 children, the group-I had 57 children with documented previous UTIs history while group-II had 66 children with no previous UTIs and was referred to as a control group. All the patients were VUR diagnosed and were thoroughly followed up at a Renal Unit of single tertiary. UTI recurrence was referred to more than one follow-up episode. A regression model was used for independent variables identification regarding UTI recurrence. . A questionnaire on bowel habits was provided to the parents. The abdominal plain film was evaluated by the observer and recorded on the documented scoring system. The constipation history was compared with the radiological and symptomatic scores. Organism single species with &gt; 105/ml count in a single midstream catch of urine sample was reflected as UTI evidence. Result: Out of 123 children, 88 (71.5%) were females while 35 (28.5%) were male. A total of 123 children had been investigated for UTI complaints. After the multivariable analysis adjustment, five recurrent UTIs predictor variables were the clinical presentation of UTI, female gender, reflux several grades, age less than 6 months, and syndrome dysfunction elimination. The UTIs recurrence risk factors were classified as high, medium, and low with prevalence 52 (42%), 41 (34%), and 30 (24%) respectively. The prevalence of UTIs rate per person-month was 10.9 (95% CI, 9.8, 12.7), 8.2 (95% CI, 6.7, 9.1) for medium, and 5.2 (95% CI, 3.3, 5.5) for the low-risk group. Conclusion: The formulation of therapeutic strategies can be done based on prediction model for UTIs recurrence besides early detection of morbidity long-term risk for the patients. Keywords: Vesicoureteral reflux, Urinary tract infection, Dysfunctional voiding, Constipation

Evaluating the Safety of Performing Flexible Cystoscopy When Urinalysis Suggests Presence of “Infection”: Results of a Prospective Clinical Study in 2350 patients

BackgroundThere is significant underutilisation of allocated health service resources when a scheduled flexible cystoscopy (FC) is cancelled because a pre-cystoscopy urinalysis (PCU) suggests “infection”, despite patients being asymptomatic for urinary tract infection (UTI). ObjectiveTo evaluate the risk of UTI or urinary sepsis when FC is performed in asymptomatic patients with a PCU positive for leucocyte esterase and/or nitrites. Design, setting, and participantsA prospective cohort study was conducted in a high-volume UK centre recruiting all patients undergoing outpatient FC. InterventionA protocol was developed to guide response to PCU performed prior to FC, which was performed regardless of the result, unless patients were symptomatic for UTI. All patients completed a questionnaire to identify risk factors and were followed up via a telephone survey and a review of electronic clinical records. Outcome measurements and statistical analysisPost-FC UTI was defined as hospital admission with UTI/urinary sepsis or if patients were symptomatic for UTI with receipt of antibiotics or with positive urine culture and sensitivity. An analysis of the association was performed. Results and limitationsAn initial pilot study confirmed the safety and feasibility of our protocol. Of 1996 patients, 136 (6.8%) developed a UTI by our definition, with 51 (2.6%) having a culture-proven infection. The risk was higher in patients with a positive PCU (odds ratio [OR] 1.61, 95% confidence interval [CI] = 1.07–2.40, p = 0.02), history of UTI (OR 1.72, 95% CI = 1.09–2.73, p = 0.02), or a bladder tumour on FC (OR 2.22, 95% CI = 1.27–3.90, p = 0.005). No patient with a positive PCU developed urinary sepsis. The main limitation of this study was the lack of pre-protocol control. ConclusionsWe observed a clinically low and acceptable risk of UTI, with no incidence of sepsis, when FC was performed in asymptomatic patients with a PCU suggesting “infection”. Routine cancellation of these patients is unnecessary and may worsen the burden on health service resources. Patient summaryWe evaluated the safety of performing flexible cystoscopy when the urine dipstick on the day suggested presence of an “infection” but the patient had no symptoms of urinary tract infection (UTI). Our study in over 2000 patients demonstrated a low incidence of UTI, and none of these patients developed sepsis. We therefore recommend that flexible cystoscopy should not be cancelled automatically on the basis of the dipstick result alone, as it might delay a time-sensitive crucial diagnosis.

Trends and Factors Associated with Neonatal Sepsis at Ruhengeri Referral Hospital, Rwanda

Neonatal sepsis is estimated to cause 26% of all neonatal mortality globally including Africa with 17% neonatal deaths. Early diagnosis and management can considerably decrease the risk of neonatal sepsis, and improve the outcome. This study aimed to determine trends and the risk factors associated with neonatal sepsis at Ruhengeri Referral Hospital from 2018 to 2019. A total of 1220 neonates’ medical files were reviewed. Data were recorded and analyzed by using SPSS. Logistic regression analysis was used to estimate factors associated with neonatal sepsis, 5% was considered as significance level. Results showed that the majority of neonates 57.4% were females, 53.9% of neonates had 0-7 days while 46.1% had more than 7 days of birth. The total cases of neonatal sepsis from January to December 2018 were found to be 207 with an average of 17 cases per month whereas there were 165 cases from January to December 2019 with an average of 14 cases per month. Research findings revealed that rupture of membranes (AOR=3.6; 95% CI: (1.34-4.76); p&lt;0.001) and prolonged labour (AOR=1.5; 95% CI: (1.12-2.43); p&lt;0.001) were associated with neonatal sepsis. Vaginal delivery and no history of urinary tract infection were protective factors to neonatal sepsis occurrence. The study also observed that the majority of the neonates had early onset of sepsis (&lt;7 days). Hence, encouraging mothers to use antenatal care services might help identify the risk factors and possible interventions to reduce the risk factors of adverse birth outcomes including neonatal sepsis.

Comparison of retrograde intrarenal surgery and standard percutaneous nephrolithotomy for management of stones at ureteropelvic junction with high-grade hydronephrosis

Percutaneous nephrostomy (PCNL) and retrograde intrarenal surgery (RIRS) are the two main treatments for upper urinary tract stones. The aim of our study was to compare the effectiveness and safety of standard PCNL (S-PCNL) and RIRS for the treatment of stones at ureteropelvic junction with high-grade hydronephrosis. The study included 118 patients who underwent surgery for stones at ureteropelvic junction. S-PCNL and RIRS were performed on 66 and 52 patients, respectively. Patient age, sex, body mass index (BMI), stone side, history of urinary tract infection (UTI), history of diabetes, history of ESWL, stone size, Hounsfield unit (HU) values of stones, grade of hydronephrosis, operating time, postoperative hemoglobin loss, narcotic analgesic use, postoperative transfusion rates, stone-free rates (SFRs), length of hospital stay, complication rates and number of secondary interventions were recorded. The comparison of the operative data between the two groups revealed no statistically significant differences in the operative time, SFRs, narcotic analgesic use, postoperative transfusion rate or other postoperative complications defined according to the Clavien system (P > 0.05). The postoperative urinary sepsis rate in the RIRS group was as high as 15.4%, which was much higher than the 1.5% rate observed in the S-PCNL group, and the difference was statistically significant (P < 0.05). A total of 13.5% of the patients in the RIRS group required a second operation due to failure of the placement of the ureteral access sheath. Additionally, S-PCNL had an advantage in operation time, while RIRS in duration of hospital stay and postoperative hemoglobin loss. RIRS and S-PCNL were safe and effective methods for the treatment of stones at ureteropelvic junction with high-grade hydronephrosis. Importantly, S-PCNL had more advantages in terms of the postoperative urinary sepsis rate and secondary surgery rate.

Therapeutic efficacy of biofeedback pelvic floor muscle exercise in women with dysfunctional voiding

Dysfunctional voiding (DV), a voiding dysfunction due to hyperactivity of the external urethral sphincter or pelvic floor muscles leading involuntary intermittent contractions during voiding, is not uncommon in neurologically normal women with lower urinary tract symptoms (LUTS). We aimed to investigate the therapeutic efficacy of biofeedback pelvic floor muscle training (PFMT) in female patients with DV and to identify the therapeutic efficacy. Thirty-one patients diagnosed with DV. All participates completed the 3-month biofeedback PFMT program, which was conducted by one experienced physiotherapist. At 3 months after treatment, the assessment of treatment outcomes included global response assessment (GRA), and the changes of clinical symptoms, quality of life index, and uroflowmetry parameters. 25 (80.6%) patients had successful outcomes (GRA ≥ 2), and clinical symptoms and quality of life index significantly improved after PFMT. Additionally, uroflowmetry parameters including maximum flow rate, voided volume, voiding efficiency, total bladder capacity, voiding time, and time to maximum flow rate significantly improved after PFMT treatment. Patients with the history of recurrent urinary tract infection in recent 1 year were found to have unsatisfied therapeutic outcomes. In conclusion, biofeedback PFMT is effective in female patients with DV with significant improvements in clinical symptoms, quality of life, and uroflowmetry parameters. The history of urinary tract infection in recent 1 year is a negative predictor of successful outcome.

Identification of Risk Factors for Invasive Extraintestinal Pathogenic Escherichia coli (ExPEC) Disease

Background: A pathogenic group of invasive extraintestinal pathogenic (ExPEC) Escherichia coli possess the ability to infect normally sterile body sites and cause severe invasive ExPEC disease (IED). ExPEC is a leading cause of bacteremia and sepsis worldwide and is associated with older age and multidrug-resistant infections. Janssen Vaccines &amp; Prevention is developing a novel multivalent glycoconjugate vaccine to prevent IED. We aimed to use an unbiased approach, with no prespecified potential risk factors, using machine-learning models, to screen for and identify IED risk factors for further validation. Methods: We used a patient-level prediction study design to model the probability of a patient developing IED within 14 days to 1 year from a given date based on their prior 2 years of health records. We used the Optum EHR database (~98 million subjects) in the common data model (CDM) format, with health features encoded in the following categories: conditions, procedures, drugs, healthcare visits, recent laboratory measurements, and age and gender. A gradient boosting model (XGBoost) was used with Shapley additive explanation (SHAP) values to identify which features were most important to the model’s decisions and to characterize precisely the relationship between features and outcomes (binary or continuous). Results: Study participants were aged ≥60 years at index with no previously recorded IED. Of ~6,500,000 cases included, ~8,000 had IED during the prediction window. We found that having ≥1 urinary tract infection (UTI) in the retrospective period increased the model’s probability of predicting IED for that patient, with more frequent or more recent UTIs increasing IED prediction chance (Figure 1). Higher age linearly increased the model’s likelihood of predicting that a patient would develop IED. The model also identified ≥1 inpatient or ER visit and laboratory values indicative of renal or immune dysfunction to be correlated with increased IED risk. This methodology is a generalizable approach to screening for potential risk factors for an outcome using EHR databases; it requires little to no prespecification of the health factors or precise relationship between the factors and outcome. Conclusions: Using a new, impartial methodology (with no prespecification), older age and a history of UTIs were key predictive features for IED, factors previously identified through traditional analysis, confirming the validity of the methodology. Novel features, including recent hospitalization, were shown to increase IED risk relative to existing criteria. Our findings may be used to inform the clinical development of preventive strategies.Funding: Janssen Research and DevelopmentDisclosures: None

İdrar yolu enfeksiyonu ile tuvalet tipi arasında ilişki var mı?

Aim: Many metabolic, physiological, and social factors play a role in the formation of infections. The results of the studies investigating the association between toilet type and urinary tract infection (UTI) are contradictory. This study aims to investigate the relationship between UTI and toilet habits and toilet type used. Methods: A cross-sectional study, including 344 participants between the ages of 18-60, was conducted. Sociodemographic information, toilet preferences, toilet habits, diagnosed chronic diseases, and histories of UTI were questioned with a structured questionnaire. Results: Front-to-back wiping, use of urinals in public places, and use of toilet paper were associated with a history of UTI in some genders. No significant relationship was observed between the parameters of general toilet preference, type of toilet preferred at home, and the frequency of water closet use, and UTI history in both genders. Conclusion: The toilet preference and some toileting habits may play a role in UTI. Further studies are required to reveal the real significance of this association.