Lower Urogenital Tract Research Articles

A discussion on gonorrhoea

Gonorrhoea, a sexually transmitted disease (STD) caused by bacterium Neisseria gonorrhoea.It’s also sometimes called “the clap” or “drip.” It is the second most common STI and commonly co-occurs with other STIs (especially chlamydia trachomatis). It mostly affects the genital tract and genital area, also if the organism comes in contact with mucous membrane this can lead to infection, such as infections in lower urogenital tract, pharynx, anus/rectum, conjunctiva (eyes). Gonorrhoea is spread through sexual fluids, including vaginal fluid and semen. Often, gonorrhoea doesn’t cause symptoms, especially in people assigned female at birth. When present, symptoms differ. It could lead to long-term health problems and infertility, but antibiotics can cure it and reduce the chance of complications.

Trichomonas vaginalis adherence phenotypes and extracellular vesicles impact parasite survival in a novel in vivo model of pathogenesis.

Trichomonas vaginalis is a human infective parasite responsible for trichomoniasis-the most common, non-viral, sexually transmitted infection worldwide. T. vaginalis resides exclusively in the urogenital tract of both men and women. In women, T. vaginalis has been found colonizing the cervix and vaginal tract while in men it has been identified in the upper and lower urogenital tract and in secreted fluids such as semen, urethral discharge, urine, and prostatic fluid. Despite the over 270 million cases of trichomoniasis annually worldwide, T. vaginalis continues to be a highly neglected organism and thus poorly studied. Here we have developed a male mouse model for studying T. vaginalis pathogenesis in vivo by delivering parasites into the murine urogenital tract (MUT) via transurethral catheterization. Parasite burden was assessed ex-vivo using a nanoluciferase-based gene expression assay which allowed quantification of parasites pre- and post-inoculation. Using this model and read-out approach, we show that T. vaginalis can be found within MUT tissue up to 72 hrs post-inoculation. Furthermore, we also demonstrate that parasites that exhibit increased parasite adherence in vitro also have higher parasite burden in mice in vivo. These data provide evidence that parasite adherence to host cells aids in parasite persistence in vivo and molecular determinants found to correlate with host cell adherence in vitro are applicable to infection in vivo. Finally, we show that co-inoculation of T. vaginalis extracellular vesicles (TvEVs) and parasites results in higher parasite burden in vivo. These findings confirm our previous in vitro-based predictions that TvEVs assist the parasite in colonizing the host. The establishment of this pathogenesis model for T. vaginalis sets the stage for identifying and examining parasite factors that contribute to and influence infection outcomes.

Prevalence and antibiotics resistance of Ureaplasma species and Mycoplasma hominis in Hangzhou, China, from 2013 to 2019.

Ureaplasma spp. and Mycoplasma hominis, frequent colonizers in the lower urogenital tract, have been implicated in various infections, with antibiotic resistance growing and varying regionally. This study aims to investigate the prevalence and antibiotic resistance profiles of Ureaplasma spp. and M. hominis in outpatients in Hangzhou, China, from 2013 to 2019. A total of 135,263 outpatients were examined to determine the prevalence of Ureaplasma spp. and M. hominis, including 48,638 males and 86,625 females. Furthermore, trends in antibiotic susceptibility of Ureaplasma spp. and M. hominis during 1999–2019 were analyzed. The cultivation, identification, and antibiotic susceptibility of the bacteria (ofloxacin, ciprofloxacin, erythromycin, clarithromycin, azithromycin, josamycin, tetracycline, doxycycline, and pristinamycin) were determined using the Mycoplasma IST2 kit. Our study indicated that the overall prevalence of total Ureaplasma spp./M. hominis was 38.1% from 2013 to 2019. Ureaplasma spp. were the most frequently isolated species (overall prevalence, 31.3%), followed by Ureaplasma spp./M. hominis coinfection (6.0%) and single M. hominis infection (0.8%). The prevalence of Ureaplasma spp. and M. hominis was significantly higher in females than in males, and the highest positive rates of total Ureaplasma spp./M. hominis were observed in both female and male outpatients aged 14–20 years. During 2013–2019, josamycin, tetracycline, doxycycline, and pristinamycin maintained exceptionally high activity (overall resistance rates, <5%) against both Ureaplasma spp. and M. hominis, but ofloxacin and ciprofloxacin showed limited activity (overall resistance rates, >70%). During 1999–2019, the rates of resistance to ofloxacin and ciprofloxacin increased against both Ureaplasma spp. and M. hominis but decreased to erythromycin, clarithromycin, azithromycin, tetracycline, and doxycycline against Ureaplasma spp. In conclusion, our study demonstrates a high prevalence of Ureaplasma spp. compared to M. hominis and Ureaplasma spp./M. hominis, and their distribution was associated with sex and age. Josamycin, doxycycline, and tetracycline are promising antibiotics that have remarkable activity against Ureaplasma species and M. hominis.

Maternal mortality: The role of Mycoplasma hominis and its impact on neonatal health

Maternal mortality remains a public health challenge. Every day, approximately 800 women die worldwide from causes related to pregnancy and childbirth that can be prevented. Maternal mortality continues to be prevalent in developed countries and developing countries with infections being one of the major causes of this canker, these include genital mycoplasma infections. Mycoplasma hominis (M. hominis) is a facultative human pathogen that is mostly detected in the lower urogenital tract in sexually active healthy men and women. It is known to have adverse effects on the outcome of pregnancy. M. hominis has been identified in women from family planning and prenatal clinics much more frequently and it has been associated with pyelonephritis, pelvic inflammatory disease, postpartum septicemia, endometritis, and preterm birth. M. hominis also affects neonatal health leading to respiratory distress, neonatal meningitis, and congenital pneumonia. This review provides an overview of the current knowledge on Mycoplasma hominis , the dangers it poses to maternal and neonatal health, and its detection and treatment.

Microbiome and skin

The human skin is a dynamic ecosystem inhabited by bacteria, mites, fungi and viruses. This set of microorganisms living on the skin and mucous membranes of the oropharynx, upper respiratory tract, conjunctiva, colon and lower urogenital tract, is called „normal flora“ (physiological, natural, autochronous, microbiome, microbiota) and is essential for skin physiology and immunity. The development of molecular methods to identify microorganisms has led to an emerging view of the resident skin bacteria as highly diverse and variable. An enhanced understanding of the skin microbiome is necessary to gain insight into microbial involvement in human skin disorders and to enable novel promicrobial and antimicrobial therapeutic approaches for their treatment.

Placental inflammatory changes and their association with the vaginal microbiota before delivery

Hypothesis/aims of study: Infection of the amniotic cavity and placenta is one of the leading causes of adverse pregnancy outcomes. In the majority of cases, intra-amniotic infection is associated with the normal microbiota of the lower urogenital tract. The aim of the study was to explore the relationships between the placental inflammatory changes, vaginal microbiota and labor course.&#x0D; Study design, materials and methods: We examined 124 women at 37-41 weeks of gestation. The vaginal discharge at admission was taken for microbiological evaluation, with the delivered placenta sent for histological examination.&#x0D; Results: In 17.7% of cases, histological examination of the placenta revealed inflammatory changes. A statistically significant correlation was noted between the placental inflammatory changes and Staphylocossus spp. presence in the vaginal discharge at admission (р = 0.0004). The placental inflammatory changes were associated with the membrane rupture to delivery interval more than 6 hours (р = 0.01) and the labor duration more than 7 hours (р = 0.0004). Prelabor rupture of membranes did not significantly affect the placental inflammatory changes (p = 1.0).&#x0D; Conclusion: Predisposing factors for the development of ascending bacterial infection of the placenta are an abnormal vaginal microbiota with the presence of opportunistic bacteria before delivery, a long membrane rupture to delivery interval, and a prolonged labor.

Bladder rupture due to urogenital tract trauma caused by ox horn injury in a patient with pelvic organ prolapse: a case report

IntroductionGenitourinary tract trauma caused by ox horn injury in the presence of pelvic organ prolapse (POP) is an extremely rare phenomenon and associated with devastating morbidity.Case presentationA 50-year-old multiparous postmenopausal woman from rural northwest Ethiopia presented with the primary complaint of urinary incontinence 6 days after she suffered ox horn injury to her prolapsed genitalia. She had stage 3 pelvic organ prolapse with the leading point being the cervix. The anterior vaginal and posterior bladder walls were disrupted with visible draining of the left ureter. The wound was dirty and edematous with whitish discharge. She was admitted to the urogynecology ward and provided with wound care until the infection subsided. Apical prolapse suspension was performed using right sacrospinous fixation, and bladder repair was carried out 6 weeks following the prolapse suspension. She recovered well and was continent when discharged.ConclusionOx horn injury involving the female lower urogenital tract in the presence of POP is extremely rare. Late presentation after sustaining injury is associated with increased risk of morbidity and long hospital stay, and treatment requires multistage surgery.

Prevalence and Antimicrobial Susceptibility of Mycoplasma hominis and Ureaplasma Species in Nonpregnant Female Patients in South Korea Indicate an Increasing Trend of Pristinamycin-Resistant Isolates.

Mycoplasma hominis and Ureaplasma species, commonly found in the lower urogenital tract, have been associated with various urogenital infections. This study aimed to estimate the prevalence and antimicrobial susceptibility trend of M. hominis and Ureaplasma sp. in female patients and to evaluate the risk factors for the acquisition of pristinamycin-resistant mycoplasma. Endocervical swab specimens obtained between March 2016 and December 2018 were analyzed using a Mycoplasma IST2 kit. Because pristinamycin and josamycin are not available in South Korea, we conducted an age- and date-matched case-control study to evaluate the risk factors for the acquisition of pristinamycin-resistant isolates. Among 4,035 specimens, 1,589 (39.4%) cases were positive for genital mycoplasma, which included 49 (3.1%) cases of M. hominis, 1,243 (78.2%) cases of Ureaplasma sp., and 297 (18.7%) cases of both M. hominis and Ureaplasma species. Based on antimicrobial susceptibility tests, the antibiotic susceptible rate of both M. hominis and Ureaplasma species to pristinamycin decreased annually during the study period (100%, 97.1%, and 87.3% for 2016, 2017, and 2018, respectively, P < 0.001). According to a multivariate analysis, josamycin resistance (odds ratio, 7.18; 95% confidence interval, 1.20 to 43.00; P = 0.027) and coinfection (odds ratio, 145.38; 95% confidence interval, 21.80 to 3,017.23; P < 0.001) with Candida species were independent risk factors for the acquisition of pristinamycin-resistant isolates. Antibiotic-resistant genital mycoplasmas have been gradually increasing annually. Nationwide surveillance, proper antibiotic stewardship, and appropriate culture-based treatment strategies are required to control this upcoming threat.

NBCe1 in the Kidney and Lower Urogenital Tract

NBCe1 is an electrogenic Na+ bicarbonate cotransporter expressed as three isoforms. NBCe1A is mainly found in the kidney (100% activity), NBCe1B is a general isoform (~25% activity), and NBCe1C is found in the nervous system (20% activity). This project was to characterize mice with loss of NBCe1 in the kidney and urogenital tract and to test isoform activity ± IRBIT. Previous work has shown that NBCe1‐B is activated when IRBIT is present and interacts with the N‐terminus (Nt). Even though NBCe1C shares this Nt, the effects of IRBIT on human NBCe1C are unknown. Interstitial Cells of Cajal (ICC)pacemaker cells in the gastrointestinal tract (c‐kit+) have NBCe1C, IRBIT and require bicarbonate for normal gut activity. Developmentally similar ICC cells are found in the urogenital tract; however, NBCe1C locations within the kidney and urogenital tract are unknown. Using c‐kit‐copGFP and NBCe1A‐knockout mice, kidneys, ureters, prostate, bladder, and urethra were dissected and analyzed via direct imaging, sectioning, and immunofluorescence. Oocytes injected with NBCe1C ± IRBIT were voltage clamped to determine the cotransporter's activity. “Strings” of c‐kit+‐cells were found in the copGFP &amp; nbce1A kidneys. In nbce1(+/−)‐(Het) mice (Figure), prostate ducts appeared enlarged, and in nbce1A−/− kidney, c‐kit protein was broadly expressed, showing cluster colocalization with NBCe1C. NBCe1C is not obviously expressed in WT or copGFP mice. Electrophysiology data showed that IRBIT activates NBCe1C by ~10‐fold. As c‐kit is also a marker of stem cells, NBCe1C/c‐kit association and c‐kit increase in nbce1A−/− mice, could suggest that NBCe1A loss elicits kidney repair itself (proliferation) and causes expression of other NBCe1‐isoforms.Support or Funding InformationR25‐DK101405, R01‐DK057061, U54‐DK100227 (Mayo) and U54‐DK104310 (UW‐Madison)This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Limits of surgery in uro-oncology

The limits of cancer surgery in uro-oncology are characterized by acarefully weighed risk of surgical feasibility and oncological necessity. The limits of uro-oncological cancer surgery do not represent fixed dogmas but ideally these more or less cognitive boundaries move based on new scientific findings, improved imaging modalities, optimized surgical techniques and perioperative care. The limits of cancer surgery are defined by patient-specific parameters, the biological aggressiveness of the tumor itself, the skills and expertise of the surgeon, and adequate perioperative care of the patient. Dependent on the origin of the cancers of the upper and lower urogenital tract, the specific particularities of each individual cancer in terms of prognosis need to be known, taking into consideration the newest molecular insights and modern multimodality treatment regimes. Only the consideration of the above mentioned basics will allow the best decision to be made with the patient concerning the optimal individual treatment. The current article highlights general parameters of the patient, tumor and surgeon which might define the limits of cancer surgery in uro-oncology. In addition, specific clinical scenarios are discussed with regard to surgery limits in cancer of the kidney, the prostate and the testis.

Injuries to the Lower Urogenital Tract and Genitalia

Injury to the lower urinary tract may involve multiple organs depending on the mechanism of injury, often requiring the collaboration of both trauma and orthopedic surgeons. Although blunt trauma to the lower urogenital tract and genitalia is much more common than penetrating trauma, both mechanisms of injury can produce life-altering injury. Prompt diagnosis is imperative for optimal outcomes and may require computed tomography, ultrasonography, and urethrography to delineate the extent of injury. The nature and variety of injuries require a combination of minimally invasive, open, and plastic surgical techniques for optimal management. Particular attention is required for possible female reproductive organ injury, particularly in the setting of sexual assault. Key words: bladder injury, penile amputation, penile fracture, penile injury, scrotal trauma, urethral injury, urogenital trauma

Symbiotic Association with Mycoplasma hominis Can Influence Growth Rate, ATP Production, Cytolysis and Inflammatory Response of Trichomonas vaginalis.

The symbiosis between the parasitic protist Trichomonas vaginalis and the opportunistic bacterium Mycoplasma hominis is the only one currently described involving two obligate human mucosal symbionts with pathogenic capabilities that can cause independent diseases in the same anatomical site: the lower urogenital tract. Although several aspects of this intriguing microbial partnership have been investigated, many questions on the influence of this symbiosis on the parasite pathobiology still remain unanswered. Here, we examined with in vitro cultures how M. hominis could influence the pathobiology of T. vaginalis by investigating the influence of M. hominis on parasite replication rate, haemolytic activity and ATP production. By comparing isogenic mycoplasma-free T. vaginalis and parasites stably associated with M. hominis we could demonstrate that the latter show a higher replication rate, increased haemolytic activity and are able to produce larger amounts of ATP. In addition, we demonstrated in a T. vaginalis-macrophage co-culture system that M. hominis could modulate an aspect of the innate immuno-response to T. vaginalis infections by influencing the production of nitric oxide (NO) by human macrophages, with the parasite-bacteria symbiosis outcompeting the human cells for the key substrate arginine. These results support a model in which the symbiosis between T. vaginalis and M. hominis influences host-microbes interactions to the benefit of both microbial partners during infections and to the detriment of their host.

MicroRNAs in Bladder Outlet Obstruction: Relationship to Growth and Matrix Remodelling.

The discovery of microRNAs (miRNAs), which are ~22 nucleotide RNAs that inhibit protein synthesis in a sequence-specific manner and are present in a range of species, has born hope of new therapeutic strategies. miRNAs play important roles in development and disease, but they remain poorly studied in uropathologies beyond cancer. Here, we discuss biological functions of miRNAs in the lower urogenital tract. A special focus is on miRNAs that change in bladder outlet obstruction (BOO). This is a condition that affects nearly one third of all men over 60 years and that involves growth and fibrosis of the urinary bladder. Animal models of BOO, such as that in rat, have been developed, and they feature a massive 6-fold bladder growth over 6 weeks. Using microarrays, we have charted the miRNAs that change during the time course of this process and identified several with important modulatory roles. We discuss known and predicted functions of miR-1, miR-29, miR-30, miR-132/212, miR-204 and miR-221, all of which change in BOO. The majority of the miRNA-mediated influences in BOO are expected to favour growth. We also outline evidence that miR-29 represents a key effector molecule in a generic response to mechanical distension that is designed to counteract exaggerated organ deformation via effects on matrix deposition and stiffness. We conclude that miRNAs play important roles in bladder remodelling and growth and that they may be targeted pharmacologically to combat diseases of the lower urinary tract.

Clinical role of Ureaplasma parvum and Ureaplasma urealyticum presence in female lower urogenital tract : is there a place for routine screening and treatment?

Sexually transmitted infections represent major health problem in females all over the world if remained undiagnosed and untreated. They can have adverse influence on reproduction and health of a mother and a newborn. The development of molecular methods has permitted the detection of an array of microbes whose pathologic roles in urogenital infections need to be further studied. Ureaplasmas ( Ureaplasma spp.), being originally found in 1954 from male urogenital tract, are prokaryotic cells without a cell wall, ranging from 0.1 to 1 μm in length. Fourteen known Ureaplasma serovars have been divided in two species based on their phenotypic and genotypic features, Ureaplasma parvum and Ureaplasma urealyticum detected and identified separately using polymerase chain reaction assays. Both are generally considered as genital tract commensals. U. urealyticum is most probably associated with male urethritis which has not been found for U. parvum . Recent studies with supposedly healthy women reported their detection rate between 18-87 % for U. parvum and 6-10 % for U. urealyticum . Even though they have been found to be associated with chorioamnionitis, preterm birth and perinatal complications more commonly then other commensals in this region the rising question regarding their pathogenic role in females remains unsolved and the guidelines regarding the diagnostic screening and treatment are inconsistent. The aim of our paper is to review the microbiological characteristics, diagnostic methods and epidemiology of newly differentiated U. parvum and U. urealyticum , and to assess evidence speaking pro and contra their clinical role in causing lower urogenital tract infection in women. Since both bacteria are susceptible to antimicrobials it is of utmost importance for clinicians to decide whether or not to search for one or both of them routinely and treat accordingly in order to prevent ascending upper genital tract infection as well as complications in pregnancy and newborns.

Tissue alterations in urethral and vaginal walls related to multiparity in rabbits.

In rodents, vaginal distention after delivery or experimental manipulation affects innervations as well as the amount of striated/smooth musculature or collagen in both the urethra and vagina. These changes are associated with modifications in excretory and reproductive processes. Although successive and consecutive vaginal deliveries (multiparity) affect the contractile and functional properties of the female lower urogenital tract (LUT), its impact on LUT morphometry, including persistency, has been barely studied. The caudal urethra (CU) and cranial (V1) and caudal (V2) pelvic vaginal regions were excised from young and adult nulliparous (YN and AN, respectively) and multiparous (YM and AM, respectively) rabbits. Tissues were histologically processed and stained with Masson's trichrome. The thickness of the tissue layers and areas covered by tissue components were measured and compared using two-way ANOVA followed by Student-Newmann-Keuls tests to determine statistical differences (P ≤ 0.05). Compared to YN, YM, and AN tissues showed a reduction in the thickness of the epithelium, as well as in areas covered by striated musculature, collagen, and blood vessels of the LUT. In comparison with YM, only some morphometric changes were recovered in the AM group. Our study shows that multiparity and age can be associated with epithelial and muscular atrophy of urethral and vaginal walls. The morphometry of the LUT between young and adult female rabbits varies with multiparity. These findings may help to better understand the effects of multiparity on young and adult females and its correlation with the development of pelvic dysfunctions.

Abstract 306: Deletion of p21/Cdkn1a confers protective effect against prostate tumorigenesis in Transgenic Adenocarcinoma of the Mouse Prostate model.

Abstract Mutations in tumor suppressor genes and proto-oncogenes, and constitutively active mitogenic signaling are known to cause cell cycle deregulation and uncontrolled proliferation in tumorigenesis. Cyclin dependent kinase inhibitors (CDKIs), p21 and p27, play a determining role in G1-S transition by regulating cyclin dependent kinase (CDK) activity. While lower protein p27 expression is often associated with poor prognosis in PCa, the prognostic significance of p21 in PCa is still controversial. Whereas up regulation of p21 by anticancer agents has been shown to induce growth arrest in several androgen-dependent and -independent PCa cell lines, in many cases, the elevated p21 levels in human PCa tissues have been correlated with higher Gleason score, poor survival and increased recurrence rate of the disease. However, some reports have also associated high p21 levels with metastasis-free survival in PCa patients. Thus, these mixed observations warrant extensive studies to examine the roles of p21 molecule in PCa progression. Accordingly, in the present study, transgenic mice harboring p21/Cdkn1a homozygous deletion (p21-/-) were crossed with the transgenic adenocarcinoma of the mouse prostate (TRAMP) mice so as to characterize the in vivo consequences of p21 deletion on prostate tumor initiation and progression. At 24 weeks of age, necropsy was performed across the groups; the lower urogenital tract (LUT) weight of the p21-/-/TRAMP (male TRAMP mice with homozygous deletion of p21) mice was found to be significantly lower than the LUT weights of both p21+/-/TRAMP (male TRAMP mice with heterozygous deletion of p21) and male TRAMP mice. Detailed histopathological analysis revealed the same trend as gross pathology showing less aggressiveness in prostates of p21-/-/TRAMP. Importantly, there was a marked difference in tumor incidence between TRAMP and p21/TRAMP male mice. A significantly higher incidence of low-grade prostatic intraepithelial lesions with a concomitant reduction in adenocarcinoma incidence was observed in p21-/-/TRAMP mice compared to TRAMP mice. In addition, where TRAMP mice showed the presence of poorly differentiated adenocarcinoma lesions, no such lesions were observed in p21/TRAMP transgenic mice. Specifically, there was a significant reduction in the severity of lesions in both p21-/-/TRAMP and p21+/-/TRAMP mice compared to TRAMP mice; a better protective effect due to homozygous p21 deletion was observed in p21-/-/TRAMP mice. Overall, these results suggest the possibility that intact p21 expression is associated with PCa aggressiveness, while its decreased levels may in fact confer protection against prostate tumorigenesis. Citation Format: Anil Kumar Jain, Komal Raina, Rajesh Agarwal. Deletion of p21/Cdkn1a confers protective effect against prostate tumorigenesis in Transgenic Adenocarcinoma of the Mouse Prostate model. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 306. doi:10.1158/1538-7445.AM2013-306

Correlation of polymorphisms in genes coding cytokines TNF-α, IL-10, MBL2, IFN-γ and IL-6 with complicated course of urogenital chlamydial infection in men

Goal. To develop a personified approach to the management of men with the urogenital chlamydia infection based on studying the molecular and genetic risk factors of the development of complications. Materials and methods. Patients with the urogenital chlamydia infection (20 men with the urogenital chlamydia infection of the lower urogenital tract and 20 men with complicated forms of the urogenital chlamydia infection) and men without any clinical or laboratory signs of STDs and inflammatory diseases of the urogenital tract. The following methods were used in the study: anamnestic, clinical, instrumental (transrectal ultrasonography) and laboratory (microscopic, bacteriological, molecular and biological (PCR, SNaPshot)). Results. According to the study results, the share of cases of ureteritis caused by C. trachomatis amounted to 10.5% of the total share of cases of ureteritis and 13.0% of cases of non-gonococcal ureteritis. The percentage of complicated urogenital diseases caused by C. trachomatis amounted to 34.5% of the total share of complicated forms and 35.7% of noncomplicated forms of the non-gonococcal origin. Subjective clinical signs of complicated forms of the chlamydia infection did not have any reliable distinctions from those observed in case of non-complicated forms of the disease; the infectious process caused by C. trachomatis was characterized by the absence of leukocytosis in the urethra in 30.0% of men with both non-complicated and complicated forms of the disease. The study of the polymorphism of cytokine genes revealed that the CC genotype of IL-6 gene at the -174 locus can serve as a molecular predictor of the complicated course of urogenital chlamydiosis in men while the GC genotype of IL-6 gene at the -174 locus can serve as a molecular predictor of the non-complicated course of urogenital chlamydiosis in men. Based on these results, the authors developed an algorithm for a differential approach to the management of patients suffering from chlamydia infection. Conclusion. A differential approach to the management of men with the urogenital chlamydia infection depending on the molecular predictor of the complicated course of the disease was developed.

Gossypiboma mimicking posterior urethral stricture

INTRODUCTIONForeign bodies in the urogenital tract are not uncommon. Hairpins, glass rods, umbilical tapes, ball point pen are described in lower urogenital tract. Retained gauze piece (gossypiboma) in posterior urethra may cause diagnostic dilemma. Symptoms and investigations may mimic stricture of posterior urethra. PRESENTATION OF CASETwo cases of retained gauze pieces in the urethra are described here. The micturating cystourethrogram was suggestive of posterior urethral stricture. DISCUSSIONTwo cases described here had retained gauze piece as a cause of filling defect and abnormal appearance in the micturating cystourethrogram. Gossypiboma may be a possibility where posterior urethral stricture are seen after previous surgery in paediatric age group. CONCLUSIONIn the setting of previous urogenital surgery gossypiboma should be kept in the differential diagnosis where posterior urethral stricture are seen in the paediatric age group.

An Optimized Procedure for Fluorescence-activated Cell Sorting (FACS) Isolation of Autonomic Neural Progenitors from Visceral Organs of Fetal Mice

During development neural crest (NC)-derived neuronal progenitors migrate away from the neural tube to form autonomic ganglia in visceral organs like the intestine and lower urinary tract. Both during development and in mature tissues these cells are often widely dispersed throughout tissues so that isolation of discrete populations using methods like laser capture micro-dissection is difficult. They can however be directly visualized by expression of fluorescent reporters driven from regulatory regions of neuron-specific genes like Tyrosine hydroxylase (TH). We describe a method optimized for high yields of viable TH+ neuronal progenitors from fetal mouse visceral tissues, including intestine and lower urogenital tract (LUT), based on dissociation and fluorescence-activated cell sorting (FACS). The Th gene encodes the rate-limiting enzyme for production of catecholamines. Enteric neuronal progenitors begin to express TH during their migration in the fetal intestine and TH is also present in a subset of adult pelvic ganglia neurons . The first appearance of this lineage and the distribution of these neurons in other aspects of the LUT, and their isolation has not been described. Neuronal progenitors expressing TH can be readily visualized by expression of EGFP in mice carrying the transgene construct Tg(Th-EGFP)DJ76Gsat/Mmnc. We imaged expression of this transgene in fetal mice to document the distribution of TH+ cells in the developing LUT at 15.5 days post coitus (dpc), designating the morning of plug detection as 0.5 dpc, and observed that a subset of neuronal progenitors in the coalescing pelvic ganglia express EGFP. To isolate LUT TH+ neuronal progenitors, we optimized methods that were initially used to purify neural crest stem cells from fetal mouse intestine. Prior efforts to isolate NC-derived populations relied upon digestion with a cocktail of collagenase and trypsin to obtain cell suspensions for flow cytometry. In our hands these methods produced cell suspensions from the LUT with relatively low viability. Given the already low incidence of neuronal progenitors in fetal LUT tissues, we set out to optimize dissociation methods such that cell survival in the final dissociates would be increased. We determined that gentle dissociation in Accumax (Innovative Cell Technologies, Inc), manual filtering, and flow sorting at low pressures allowed us to achieve consistently greater survival (>70% of total cells) with subsequent yields of neuronal progenitors sufficient for downstream analysis. The method we describe can be broadly applied to isolate a variety of neuronal populations from either fetal or adult murine tissues.

Nephrektomie – pro robotisch

The last two decades have witnessed the rapid dissemination of robot-assisted laparoscopic urological surgery related to the technical advantages of this new laparoscopic tool. Master-slave systems ease intracorporeal anastomosis and the performance of technically highly demanding procedures, as reflected by a steep learning curve. Robot-assistance is particularly useful for partial nephrectomy, live-donor kidney transplantation, extended procedures, e.g. upper and lower urogenital tract resection and difficult anatomy as encountered in obese patients or patient with a history of multiple intraperitoneal procedures.