Lower Urinary Tract Pathology Research Articles

Mechanical Characterization of the Male Lower Urinary Tract: Comparison among Soft Tissues from the Same Human Case Study

Background: Nowadays, a challenging task concerns the biomechanical study of the human lower urinary tract (LUT) due to the variety of its tissues and the low availability of samples. Methods: This work attempted to further extend the knowledge through a comprehensive mechanical characterization of the male LUT by considering numerous tissues harvested from the same cadaver, including some never studied before. Samples of the bladder, urethra, prostate, Buck’s fascia and tunica albuginea related to corpora cavernosa were considered and distinguished according to testing direction, specimen conformation and anatomical region. Uniaxial tensile and indentation tests were performed and ad hoc protocols were developed. Results: The tissues showed a non-linear and viscoelastic response but different mechanical properties due to their specific functionality and microstructural configuration. Tunica albuginea longitudinally displayed the highest stiffness (12.77 MPa), while the prostate transversally had the lowest one (0.66 MPa). The minimum stress relaxation degree (65.74%) was reached by the tunica albuginea and the maximum (88.55%) by the bladder. The prostate elastic modulus was shown to vary according to the presence of pathological changes at the microstructure. Conclusions: This is the first experimental work that considers the mechanical evaluation of the LUT tissues in relation to the same subject, setting the basis for future developments by expanding the sample population and for the development of effective in silico models to improve the solutions for most LUT pathologies.

Relation between blood levels of heavy metals and some markers of oxidative stress among boys with neuropathic bladder and posterior urethral valve

BackgroundThe status of heavy metals in children with lower urinary tract pathology that may harm the upper tract, e.g., neuropathic bladder and posterior urethral valve and its relationship with oxidative stress has not been adequately investigated. Therefore, the object of the current work was to evaluate the concentrations of copper, zinc, cadmium and lead and their relations with levels of catalase (CAT), malondialdehyde (MDA) and glutathione (GSH) in boys with neuropathic bladder and posterior urethral valve. MethodsThirty-six children with neuropathic bladder, 35 children with posterior urethral valve and 33 health controls were included in the study. In addition to routine laboratory tests, blood samples were collected from patients and controls to assess levels of Cu, Zn, Cd and Pb in addition to plasma concentrations of CAT, MDA and GSH. ResultsSignificantly elevated levels of Cu, Pb, CAT, MDA and GSH and significantly lower concentration of blood Zn were found in the studied groups compared to the controls. In the posterior urethral valve group, blood level of Cu was positively correlated with GSH while a significantly negative relation was observed between blood Zn and CAT activity among the neuropathic bladder patients. ConclusionNeuropathic bladder and posterior urethral valve may lead to abnormalities in the blood levels of heavy metals (i.e. Cu, Pb and Zn) and markers of oxidative stress (CAT, MDA and GSH). Therefore, the levels of theses metal ions should be monitored during the treatment course of neuropathic bladder and posterior urethral valve patients to prevent or minimize long-term oxidative injury.

Evaluation of Galdakao-modified Valdivia Position in Combined Simultaneous Access to Upper and Lower Urinary Tract Pathologies

Abstract Background Simultaneous retrograde and antegrade endoscopic combined intrarenal surgery in modified supine lithotomy positions offer significant progress in the endoscopic management of urolithiasis. The operative time has been significantly reduced. Aim of the Work To evaluate the Galdakao-modified Valdivia position in simultaneous handling of upper and lower urological pathologies in the same units. Patients and Methods The evaluation for the Galdakao-modified Valdivia position regarding the benefits in different upper and lower urological diseases was the aim of our prospective randomized clinical trial that will started on April 2017 and ended by April 2019. Results The study has included 60 patients comprising males and females. Conclusion We believe that GMSV provided a great versatility in the treatment for urolithiasis along the whole urinary tract, ante-retrograde access, treatment of uretero-ileal strictures in patients with urinary diversions or neobladders, missed double j stent, bilharizoma of the ureter and bladder mass involving the ureteric orifice. Also, the advantage provided by this approach to the surgeon, patient and anesthetist may lead to widespread adaptability of this technique in the management of complex urolithiasis.

Haematuria in children.

Haematuria is a common finding in children and can be macroscopic or microscopic. In contrast to adults, haematuria in children very rarely indicates an underlying malignant pathology. The differential diagnosis is broad, with the most common underlying causes being infection, glomerulonephritis and hypercalciuria. It is useful to distinguish between nephrological or upper urinary tract and lower urinary tract pathologies, as this will guide investigations and referral. This review discusses the causes of haematuria in the paediatric population.

The urethra in continence and sensation: Neural aspects of urethral function.

Traditionally, the urethra has been considered a mere conduit to guide urine from the bladder to the external side of the body. Building evidence indicates that the urethra may directly influence bladder function via mechanisms restricted to the lower urinary tract (LUT). Here, we discuss the tissue arrangement of the urethra and addressed the contribution of new paraneuronal cells to LUT function. We also briefly reviewed two frequent LUT pathologies associated with urethral dysfunction. Continence depends on an intact and functional urethral sphincter, composed of smooth, and striated muscle fibers and regulated by somatic and autonomic fibers. Recent studies suggest the existence of an urethro-vesical reflex that also contributes to normal LUT function. Indeed, the urethral lumen is lined by a specialized epithelium, the urothelium, in the proximal urethra. In this region, recent evidence demonstrates the presence of specific paraneuronal cells, expressing the neurotransmitters acetylcholine and serotonin. These cells are in close proximity of nerve fibers coursing in the lamina propria and are able to release neurotransmitters and rapidly induce detrusor contractions, supporting the existence of an urethro-vesical crosstalk. The mechanism underlying the fast communication between the urethra and thebladder are beginning to be understood and should involve the interaction between specificepithelial cells and fibres innervating the urethral wall. It is likely that this reflex should bealtered in pathological conditions, becoming an attractive therapeutic target.

Tiempo de sondaje postquirúrgico recomendado para evitar complicaciones en cirugías endourológicas del tracto urinario inferior

Objetivo: Determinar el tiempo de sondaje postquirúrgico recomendado para evitar complicaciones en cirugías endourológicas del tracto urinario inferior. Materiales y métodos: Se realizó una revisión bibliográfica actualizada sobre el tiempo de sondaje postquirúrgico recomendado para evitar complicaciones en cirugías endourológicas del tracto urinario inferior. Resultados: Se encontró asociación entre un mayor tiempo de sondaje y la ocurrencia de posteriores complicaciones relacionadas cirugías endourológicas del tracto urinario inferior, siendo el período menor a 72h el óptimo para la permanencia de la sonda vesical postquirúrgica en este tipo de intervenciones. No se identificaron factores de riesgo asociados a la prolongación del tiempo de sondaje postquirúrgico. Recomendaciones: El tipo de abordaje endoscópico se ha convertido en la actualidad en el tratamiento estándar de oro para la mayoría de las patologías del tracto urinario inferior; sin embargo, se requiere realizar más estudios sobre las complicaciones y factores de riesgo relacionados al tiempo de sondaje postquirúrgico para evitar complicaciones en cirugías endourológicas del tracto urinario inferior.

Receptor Pharmacology and Other Relevant Factors in Lower Urinary Tract Pathology Under a Functional and Toxicological Approach: Instrument to Better Manage Antimicrobials Therapy.

Receptor Pharmacology and Other Relevant Factors in Lower Urinary Tract Pathology Under a Functional and Toxicological Approach: Instrument to Better Manage Antimicrobials Therapy.

Receptor pharmacology and other relevant factors in lower urinary tract pathology under a functional and toxicological approach: Instrument to better manage antimicrobials therapy

Receptor pharmacology and other relevant factors in lower urinary tract pathology under a functional and toxicological approach: Instrument to better manage antimicrobials therapy

Receptor Pharmacology and Other Relevant Factors in Lower Urinary Tract Pathology under a Functional and Toxicological Approach: Instrument to Better Manage Antimicrobials Therapy

Receptor Pharmacology and Other Relevant Factors in Lower Urinary Tract Pathology under a Functional and Toxicological Approach: Instrument to Better Manage Antimicrobials Therapy

Електрофізіологічні методи в діагностиці та лікуванні жінок з поєднаною нейрогенною патологією нижніх сечових шляхів та дистального відділу товстої кишки

Електрофізіологічні методи в діагностиці та лікуванні жінок з поєднаною нейрогенною патологією нижніх сечових шляхів та дистального відділу товстої кишки

Neuromodulation in the Treatment of Voiding Dysfunction and Fecal Incontinence in Male and Female Cancer Survivors

Sacral neuromodulation (SNM) is a widely accepted and minimally invasive treatment for several urologic lower urinary tract pathologies and bowel dysfunction. Treatment for pelvic malignancies is associated with significant rates of urinary, sexual, and fecal dysfunction. The authors sought to determine the role SNM should play in the management of voiding and fecal dysfunction in the male and female cancer survivor patient. There is a lack of studies looking at SNM in the cancer survivor population, particularly in the setting of radiation cystitis or proctitis. Regardless, the authors feel there is a role for SNM in this population. Further studies are needed to further delineate this role and the efficacy of SNM in this challenge to treat patient population. Voiding dysfunction in the cancer survivor population including urinary urgency, frequency, and urge incontinence is very common. Similarly, fecal incontinence occurs not infrequently and is a major source of patient distress. There is great evidence for SNM via InterStim in urinary urgency, urge incontinence, non-obstructive retention, and fecal incontinence. Studies are lacking, however, in the cancer survivor population. They are non-existent in the postradiation patient population. SNM is a good treatment option for urinary urgency, urge incontinence, non-obstructive urinary retention, and fecal incontinence. More studies are needed in the cancer survivor population, particularly following radiation therapy. Regardless, the authors feel there is a role in the cancer survivor for SNM.

Development of Multisegment Steering Mechanism and 3-D Panorama for Automated Bladder Surveillance System

A cystoscope is an invaluable tool for bladder cancer surveillance and lower urinary tract pathology diagnosis. The performance of cystoscopy can be improved by automating the procedure to ensure rapid and complete inspection, having a predicted pathway for imaging. This paper proposes a versatile, wire-driven, multisegment mechanism for steering an imaging probe to follow optimal, preprogrammed scan trajectories. A novel flexible imaging probe scanning fiber endoscope (SFE) of 1.2 mm in diameter generates high-quality reflectance or fluorescent images. A 3-D panoramic reconstruction view of the bladder is generated by custom software to confirm comprehensive surveillance and improve clinical efficiency. The kinematics and controllability of the proposed mechanism are analyzed. The multiple degrees-of-freedom of the mechanism provide the advantage of maintaining the camera perpendicular to the bladder wall with a safety distance. The measured experimental results show 8.1% and 5.1% tip position and orientation errors, respectively, to the theoretical simulation predictions. Within a synthetic bladder phantom made from patient-specific geometry information, the apparatus is able to generate a 3-D panorama of about 60% of the bladder's inner surface, while accepting 50% image overlap between adjacent images. The novel imaging capability of the SFE, combined with a robotized multisegment steering mechanism and an image stitching software, proposes potential advancements to the multimodal 3-D panorama of the bladder.

How to decide which infant can have robotic surgery? Just do the math

In pediatric urology, robot-assisted surgery has overcome several impediments of conventional laparoscopy. However, workspace has a major impact on surgical performance. The limited space in an infant can significantly impede the mobility of robotic instruments. There is currently no consensus on which infant can undergo robotic intervention and no parameters to help make this decision, especially for those surgeons at the start of their learning curve. We sought to evaluate our experience with infants to create an objective standard to determine which patients may be most suitable for robotic surgery. We prospectively evaluated 45 infants (24 males, 21 females), aged 3-12 months old, who underwent a robotic intervention for either upper or lower urinary tract pathology. At the preoperative office visit the attending surgeon measured the distance between both anterior superior iliac spines (ASIS) as well as the puboxyphoid distance (PXD), regardless of whether the approach was for upper or lower tract disease. Patients' weights were also noted. During surgery, we recorded the number of robotic collisions as well as console time. All surgeries were performed utilizing the da Vinci Si Surgical System by a single surgeon. There were no differences in ASIS, PXD, collisions or console time when stratified by gender, age or weight. When arranging by upper or lower tract approach, there was no difference in the number of collisions. There was a strong inverse relationship between both ASIS distance and PXD and the number of collisions. Additionally, there was a strong correlation between the number of collisions and console time (Fig. 1). Using a cutoff of 13 cm for the ASIS, there were significantly fewer collisions in the >13 cm group as compared to the ≤13 cm group. This was also true for the PXD using a cutoff of 15 cm: there were significantly fewer collisions in the >15 cm group as compared to the ≤15 cm group. Safe proliferation of robotic technology in the infant population is, in part, dependent on careful patient selection. Our data demonstrated a reduction in instrument collisions and console time with increasing anterior superior iliac spine and puboxyphoid distances. Neither age nor weight was correlated with these measurements, the number of instrument collisions or console time. Limitations include that this is a single institution study with all infants being operated on by a single surgeon. Therefore, the findings of this study may not be generalizable to a less experienced surgeon. Yet, we believe that ASIS and PXD measurements can be used as a guide for the novice surgeon who is beginning to perform robotic-assisted surgery in infants. We found that surgeon ability to perform robotic surgery in an infant is restricted by collisions when the infant has an ASIS measurement of 13 cm or less or a PXD of 15 cm or less. Objective assessment of anterior superior iliac spine and puboxyphoid distance can aid in selecting which infants can safely and efficiently undergo robotic intervention with a minimum of instrument collision, thereby minimizing operative time.

El estudio urodinámico

Introduction and objectivesUrodynamic testing is the functional evaluation of the urinary tract that allows lower urinary tract symptoms to be assessed, as well as to obtain valuable information for clinical decision making. This review aims to present an overview of the topic of the urodynamic study, its technical aspects, clinical application, and correct interpretation of results in lower urinary tract pathologies. Materials and methodsThis study is a narrative review, summarizing the information found by performing a literature search in the PubMed, MEDLINE, EMBASE databases, evidence-based guidelines, congress abstracts, as well as printed books and eBooks. Selected publications had to be in the English or Spanish language. Information from the selected articles was extracted and a summary is included in this document. ResultsThis review includes a description of the basic principles of urodynamic study, with emphasis on topics such as indications, urodynamic phases (uroflowmetry, cystometry, pressure-flow study), video-urodynamics, and electromyography. Of these topics, the normal values, the correct interpretation of results, and the application to patients with lower urinary tract symptoms, are described. ConclusionsUrodynamic study is a useful and complementary tool in making decisions on the management of lower urinary tract in both men and women. Adherence to international standards for calibration, best practices, and applicability can give optimal results, and thus useful in daily practice.© 2013 Sociedad Colombiana de Urología. Published by Elsevier España, S.L. All rights reserved.

Safety and feasibility of concomitant surgery during holmium laser enucleation of the prostate (HoLEP)

To determine the feasibility and outcomes associated with performing simultaneous surgical procedures during holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia and concomitant urologic conditions. A retrospective review of patients that underwent a HoLEP was performed. Patients undergoing a concomitant procedure at the time of HoLEP were selected and stratified based on complexity of the secondary procedure (simple, intermediate, and complex) and matched based on age and prostate volume to patients undergoing only a HoLEP. Baseline characteristics, preoperative, operative, and postoperative outcomes were collected. A total of 372 HoLEPs were performed. Thirty-eight (10.2 %) patients underwent concomitant procedures at the time of HoLEP. Compared to the simple and intermediate secondary surgical procedures, the matched control group that underwent a HoLEP alone did not demonstrate statistically significant differences in the preoperative, operative, or postoperative outcomes. Patients with a complex secondary surgical procedure at the time of HoLEP had statistically significant differences in operative time (221 vs. 65 min, p = 0.007), estimated blood loss (92 vs. 33 mL, p = 0.012), catheter time (8.5 vs. 1 day, p = 0.041), and length of hospitalization (2 vs. 1 day, p = 0.032) compared to the control group. Obstructive voiding symptoms secondary to BPH are common in older patients and may coincide with other concomitant lower urinary tract pathology that may require surgical intervention. Rather than staging surgical interventions, it appears that definitive treatment for BPH with HoLEP is safe and efficacious in those patients that also require secondary procedures.

Neurotrophins in the Lower Urinary Tract: Becoming of Age

The lower urinary tract (LUT) comprises a storage unit, the urinary bladder, and an outlet, the urethra. The coordination between the two structures is tightly controlled by the nervous system and, therefore, LUT function is highly susceptible to injuries to the neuronal pathways involved in micturition control. These injuries may include lesions to the spinal cord or to nerve fibres and result in micturition dysfunction. A common trait of micturition pathologies, irrespective of its origin, is an upregulation in synthesis and secretion of neurotrophins, most notably Nerve Growth Factor (NGF) and Brain Derived Neurotrophic Factor (BDNF). These neurotrophins are produced by neuronal and non-neuronal cells and exert their effects upon binding to their high-affinity receptors abundantly expressed in the neuronal circuits regulating LUT function. In addition, NGF and BDNF are present in detectable amounts in the urine of patients suffering from various LUT pathologies, suggesting that analysis of urinary NGF and BDNF may serve as likely biomarkers to be studied in tandem with other factors when diagnosing patients. Studies with experimental models of bladder dysfunction using antagonists of NGF and BDNF receptors as well as scavenging agents suggest that those NTs may be key elements in the pathophysiology of bladder dysfunctions. In addition, available data indicates that NGF and BDNF might constitute future targets for designing new drugs for better treatment of bladder dysfunction.

Editorial [Hot Topic: An Update on Neurotrophins (Guest Editor: Celia Duarte Cruz)

Neurotrophins are important proteins that regulate survival, development and function of neurons. They are produced by a variety of cells and exert their effects upon binding to specific tyrosine kinase receptors. The first neurotrophin to be identified was Nerve Growth Factor (NGF). From the pioneer studies performed by Rita-Levi Montalcini, awarded with the Nobel Prize, other neurotrophins have been identified and this family of neurotrophic factors now includes Brain Derived Neurotrophic Factor (BDNF), Neurotrophin 3 and Neurotrophin 4. Their function as pro-survival proteins has been consolidated but subsequent studies have demonstrated that neurotrophins may also play a role in some pathological conditions. This is the focus of this special issue of Current Neuropharmacology. The paper by Allen et al., addresses the involvement of neurotrophins, NGF and BDNF in particular, in Alzheimer’s disease and the possibility of using neurotrophin-based therapies. Frias et al., summarize studies that support the involvement of neurotrophins in the lower urinary tract (LUT) dysfunction and suggest the use of urinary neurotrophins as biomarkers of LUT pathologies. The paper by Neto et al., addresses the involvement of neurotrophins in depression, a poorly understood pathology with an increasing prevalence in Western countries. The paper by Siniscalco et al., addresses the involvement of neurotrophins in neuropathic pain, a complex pathology difficult to tackle with, and its importance as targets for neuropathic pain treatment. Teng et al., summarize the clinical uses of stem cell-based administration of neurotrophins for the treatment of spinal cord injury. This issue is published in memory of David Dawbarn, who passed away unexpectedly in January 2010. David dedicated most of his work at the Bristol University to understanding the importance of neurotrophic factors in Alzheimer’s disease, unraveling the molecular interactions between neurotrophins and their high-affinity receptors. His research was a key factor to the design of new therapies for the treatment of Alzheimer’s disease, pain and asthma. He is greatly missed by the scientific community, friends and family.

Nocturia as a manifestation of systemic disease

Nocturia is commonly referred to urologists, but the mechanisms underlying the problem, together with the appropriate clinical assessment and management, may lie outside the ordinary scope of the specialty. Some serious conditions may manifest nocturia as an early feature, often as a consequence of nocturnal polyuria (NP). Voiding frequency is influenced by rate of urine output, reservoir capacity of the bladder, lower urinary tract (LUT) sensation and psychological response. Polyuria can result from polydipsia or endocrine dysfunction. NP can result from endogenous fluid and solute shifts, cardiovascular and autonomic disease, obstructive sleep apnoea, and chronic kidney disease. Nocturia without polyuria occurs in the presence of LUT pathology, pelvic masses and sleep disturbance. Drug intake can contribute to, or counteract, each of these problems. In assessing nocturia, clinicians need to consider an undiagnosed serious condition that may manifest nocturia as an early feature, or suboptimal management of a known condition. The frequency-volume chart is a key tool in categorizing the basis of nocturia, identifying those patients with global polyuria or NP, for whom involvement of other specialties is often necessary for assessment and management. Treatment should be directed at the cause of the problem, with a view to improving long-term health and health-related quality of life. Simple steps should be undertaken by all patients, including improvement of the sleep environment and behaviour modification. Evaluation of treatment response requires objective data to corroborate subjective impressions. Some mechanisms of nocturia do not reliably improve with treatment, leading to refractory symptoms.

Runner’s Bladder: Exercise-Induced Hematuria With Lower Urinary Tract Pathology

Runner’s Bladder: Exercise-Induced Hematuria With Lower Urinary Tract Pathology

V1547 TECHNIQUE OF ROBOTIC VESICOVAGINAL FISTULA REPAIR

You have accessJournal of UrologyReconstruction1 Apr 2010V1547 TECHNIQUE OF ROBOTIC VESICOVAGINAL FISTULA REPAIR Hany Atalah, Li Ming Su, and Linda Morgan Hany AtalahHany Atalah More articles by this author , Li Ming SuLi Ming Su More articles by this author , and Linda MorganLinda Morgan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1299AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post-hysterectomy vesicovaginal fistula is a rare event that is associated with significant quality of life consequences. Minimally invasive approaches for vesicovaginal fistula repair have been described. As robotic surgery has expanded to address both upper and lower urinary tract pathology, herein we describe our step-by-step technique of robot assisted vesicovaginal fistula repair. METHODS This instructional video is of a 64 year old female who suffered a vesicovaginal fistula following a prior robotic hysterectomy. Vaginal approach to the fistula was deemed impossible due to the proximal location of the fistula as well as the patient's extremely narrow introitus. The procedure was performed in the dorsal lithotomy position using a 4-armed technique with the da Vinci S system. Ureteral stents were placed intraoperatively to identify the location of the ureters in proximity to the fistula. The vesicovaginal fistula was defined by endoscopic placement of a guidewire through the fistulous tract. The vesicovaginal fistula was excised repaired in multiple layers including interposition of omentum. RESULTS The total operative time was 3.5 hours with minimal blood loss. The patient was discharged on postoperative day #1 and returned for a cystogram study after two weeks of catheter drainage. The patient experienced no complications and has complete continence at this time. CONCLUSIONS Robotic surgery has expanded to address complex reconstructive urologic surgery including vesicovaginal fistula repair. Robot assisted repair may be utilized for proximally located fistulas and is an alternative to open or laparoscopic surgical repair with low morbidity and minimal blood loss Gainesville, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e596 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hany Atalah More articles by this author Li Ming Su More articles by this author Linda Morgan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...