Normal Urinary Flow Research Articles

PENILE TORSION OF A TWO-YEAR-OLD BOY: A CASE REPORT

Objective: This case report presented Penile Torsion in pediatrics. Case(s) Presentation: A two-year-old boy with a chief complaint of rotated penile to the right side since birth. There were 45º in clockwise torsion, slight chordee, and uncircumcised. Patient underwent penile reconstruction surgery, including penile degloving, urethral mobilization, and plication. After seven days follow-up, parents were satisfied with straight penile erection and no torsion at all. After 3 months follow-up, parents reported satisfaction with the surgical outcome such as cosmetic appearance, straight erection, and normal stream urine. Discussion: Surgical techniques ranging from simple penile degloving with foreskin repositioning to more complex surgical procedure involving corporeal tissue. Surgery by using degloving of penile skin and realignment could be suitable for penile torsion <90°. For the cases of >90°, other techniques should be considered such as corporopexy procedure, rotation flap of dorsal dartos, or diagonal suturing of corporeal folds away from and parallel to the neurovascular bundle. Conclusion: Penile reconstruction surgery using penile degloving, urethral mobilization, and plication for penile torsion showed satisfaction result including cosmetic appearance, penile erection, and normal urine flow.
 Keywords: Chordee, penile reconstruction, penile torsion.

This Month in Adult Urology

This Month in Adult Urology

PBPK Simulation-Based Evaluation of Ganciclovir Crystalluria Risk Factors: Effect of Renal Impairment, Old Age, and Low Fluid Intake

Dosing guidance is often lacking for chronic kidney disease (CKD) due to exclusion of such patients from pivotal clinical trials. Physiologically based pharmacokinetic (PBPK) modelling supports model-informed dosing when clinical data are lacking, but application of these approaches to patients with impaired renal function is not yet at full maturity. In the current study, a ganciclovir PBPK model was developed for patients with normal renal function and extended to CKD population. CKD-related changes in tubular secretion were explored in the mechanistic kidney model and implemented either as proportional or non-proportional decline relative to GFR. Crystalluria risk was evaluated in different clinical settings (old age, severe CKD and low fluid intake) by simulating ganciclovir medullary collecting duct (MCD) concentrations. The ganciclovir PBPK model captured observed changes in systemic pharmacokinetic endpoints in mild-to-severe CKD; these trends were evident irrespective of assumed pathophysiological mechanism of altered active tubular secretion in the model. Minimal difference in simulated ganciclovir MCD concentrations was noted between young adult and geriatric populations with normal renal function and urine flow (1 mL/min), with lower concentrations predicted for severe CKD patients. High crystalluria risk was identified at reduced urine flow (0.1 mL/min) as simulated ganciclovir MCD concentrations exceeded its solubility (2.6–6 mg/mL), irrespective of underlying renal function. The analysis highlighted the importance of appropriate distribution of virtual subjects’ systems data in CKD populations. The ganciclovir PBPK model illustrates the ability of this translational tool to explore individual and combined effects of age, urine flow, and renal impairment on local drug renal exposure.Graphical

Повреждения головки полового члена при обрезании крайней плоти: причины, способы лечения и меры профилактики

INTRODUCTION Penile glans amputation during circumcision is a rare but potentially devastating complication. The mechanism and causes are poorly understood and incomprehensible. It is important to identify the causes of these complications, to suggest a mechanism and to propose prevention measures. MATERIALS Between 2005 and 2019, six patients with penile glans amputationafter circumcision were analyzed. All were operated without medical evidence, for religious reasons. THE RESULTS The operations were performed by local anesthesia, at home - in 5 patients, in 1 child - at polyclinic. All children were circumcised by scalpel with guillotine method, without visualization of glans. Partial amputation of penile glans was observed in 2 children (33.3%). Complete cut-off of the glans at the level of the coronal sulcus was revealed in 4 boys (66.6%). Meatoplasty with urethral mobilizations was performed 2 patients (33.3%) with partial amputation. The tops of corpus cavernous was covered of with the remnants of the skin of penile shaft in two boys (33.3%). Glansplasty was performed in 2 other patients (33/3%), using a labial mucosa graft to reconstruct the shape of glans and glanular groove. The follow up have showed meatostenosis in two boys (33.3%) in the first 2 months after surgery. One child required repeated meatoplasty (16.6%), another had a recovery of normal urine flow rates after urethral dilatation and stenting (4 weeks). CONCLUSION Visual control of the glans position during circumcision will prevent the amputation. Guillotine techniques including, Mogen clamp-type devices, are considered potentially dangerous. Circumcision in newborns, without general anesthesia, in the presence of swelling of the foreskin have an increased risk of glans damage. Preliminary examination of the glans and adequate release of preputial adhesions help to prevent complication of circumcision and to identify combined malformations (hypospadia, epispadia, concealed penis.).

Successful treatment and long‐term outcome of a traumatic urethral laceration in a 3‐week‐old puppy

AbstractA 3‐week‐old male German Shepherd was referred to treat the complications of a first intervention following a bite injury occurring a few hours after birth. Physical examination revealed preputial stenosis, with urine collection in the preputial fornix and deep lacerations of the glans and urethra. Prepuce resection and partial penile amputation followed by prescrotal urethrostomy was performed to treat the clinical condition. The immediate postoperative follow‐up showed good conditions of the surgical wound and normal urinary flow. The dog had a normal stoma size without dysuria at the latest follow‐up examination 4 years post‐operatively. Despite the young age of the patient, the prescrotal urethrostomy treatment was successful at short‐ and long‐term follow‐up, without complications.

Endoscopic Internal Urethrotomy Outcomes in the Management of Male Urethral Strictures

Background: The aim of this study was to evaluate the outcomes of stricture treatment using endoscopic internal urethrotomy in the male urethra. Patients and Methods: We conducted a retrospective study from 2012 to 2017 at the Urology and Andrology Department of the University Hospital in Brazzaville, Congo. Medical records of 30 patients who underwent endoscopic internal urethrotomy for urethral stricture were analyzed. We studied the following variables: frequency of urethral stricture, age of patient, onset, cause and location of urethral stricture, duration of bladder catheterization, duration of hospitalization, and postoperative complications. The treatment outcome was assessed after a follow-up of 2.6 years (extreme: 2 and 4 years). Outcomes were considered successful or good when the patients had a normal urine flow and an unobstructed urethra at the Retrograde Urethrogram (RUG). Results: The mean age was 47.5 ± 9.7 years (range: 17 to 83 years). Dysuria was the most common symptom reported. We found that urethral stricture was mostly caused by infectious diseases (20 patients). The urethral stricture was located at the membranous urethra in 4 patients, the bulbar urethra in 25 patients, and the penile urethra in 1 patient. The mean duration of the bladder catheterization was 2.3 days. Hospitalization duration was 36 hours. We observed the following complications: urethrorrhagia in 3 patients, acute orchiepididymitis. We achieved good results in 23 patients. Conclusion: In our context where the practice of endoscopic internal urethrotomy is recent, it provides satisfactory results for the treatment of short urethral male stricture.

Urosepsis in adults

Urosepsis is defined as sepsis caused by urinary tract infection (UTI). Urosepsis represents a quarter of all cases of sepsis in adults. Complications of UTIs are the most common risk factor for urosepsis development. These infections, especially pyelonephritis, often occur in patients with structural or functional malformations that interfere with normal urine flow. The problem of a significant increase in UTIs with multiresistant bacteria should be emphasized, especially in patients with recurrent UTI and their frequent treatments. As the urogenital tract is one of the most common sources of infection in sepsis in general, a detailed assessment of the tract should be carried out in all septic patients. Even though urosepsis is associated with a relatively good prognosis and lower mortality than sepsis of another etiology, it occurs rapidly and progresses at a significant speed. Since urosepsis is mainly the result of obstruction of the urinary tract, the development of septic shock can most often be prevented by implementing early deobstruction. Knowledge of the most common causes of urosepsis and the category of high-risk patients will provide clinicians with the tools with which to prevent its occurrence.

The Profile of Patients Presented at Nephrology Opd With Obstructive Nephropathy; Single Centre Experience

Introduction: Obstructive Uropathy which refers to the structural and functional change impeding the normal urine flow is one of the common cause of renal failure . It has diverse effect on normal renal function as well as there is also diversity on its etiology and outcome Material & methods: Total 108 patients who came to Nephrology OPD with various degree of renal dysfunction resulting from Obstruction of Urinary tract was included in the study. Result : Among the patients 65% were male and their mean age was 51±13.5 years . Common clinical features were loin pain (41%) ; vomiting (30%) ; edema (26%) ; Oligourea (46%) & LUTS (19%). Common etiologies of Obstruction was BEP (28.7%);Urolithiasis(24%); Cervical malignancies(11%); Congenital abnormalities (13%) & stricture urethra(12%). About 37% patients had to under go RRT. Conclusion : Specific strategies to target improvements in early diagnosis renal recovery and patients survival are needed in this patient group. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.132-135

Urine flow analysis using double J stents of various sizes in in vitro ureter models.

A double J stent (DJS) is used to alleviate the congestion of urine in the upper urinary tract when there is ureteral stenosis, which causes the interruption of normal urine flow and results in renal failure. The purpose of placing DJSs is to ensure sufficient urine flow in the ureter, but the DJS acts as a foreign body in the urinary system and sometimes acts as an obstacle in achieving sufficient urine flow. Here, to evaluate the performance of various sizes of DJSs, 5Fr (1.666 mm) to 8Fr (2.666 mm), in the ureter, silicon ureter models without stenosis, and a circulation setup were constructed. The total flow rates (TFRs) in the stented ureters were evaluated with an in vitro experiment. The TFRs in the 5Fr DJS were larger than those in the other sizes of DJS. As the size of DJS increased, the TFR decreased. Computational fluid dynamics was also applied to validate the experimental results. It was shown that the experimental results agreed well with the numerical results.

Development of microemulsion of tamsulosin and dutasteride for benign prostatic hyperplasia therapy

Benign prostatic hyperplasia (BPH) is a condition characterized by a benign enlargement of the prostate that interferes with the normal flow of urine. This disease is treated with the oral administration of combination therapy comprising α-blockers (tamsulosin) and 5α-reductase inhibitors (dutasteride). However, these compounds have low bioavailability. Thus, transdermal microemulsions aimed at promoting permeation and efficient targeted drug delivery through the skin are used. The objectives of this study were to obtain microemulsions of the combined doses of dutasteride and tamsulosin and evaluate their anti-hyperplastic activity in vivo. A phase diagram (4:1) was obtained for the choice of microemulsions. The microemulsions were characterized in terms of the droplet size, rheology, pH, conductivity, refractive index, in vitro release profile, and antihyperplastic effect in vivo. A method for the simultaneous quantification of drugs was developed using UV–vis spectroscopy. The microemulsions had an average size less than 116 nm, an acidic pH and low viscosity. The conductivity ranged from 6.18 to 185.2 μS/cm. The in vitro release profile was sustained for 6 h. Microemulsions promoted the reduction in the size of testosterone-dependent organs (prostate and seminal vesicles). Transdermal formulations for the treatment of BPH were obtained as a therapeutic alternative to conventional treatments.

Modified Tubularised Incised Plate Urethroplasty (TIPU) with Dorsal Inlay Preputial Skin Graft: An Outcome Evaluation of 21 cases

There are different techniques of hypospadias repair, out of them TIPU is widely practiced and popular procedure. Here a midline incision is made over the urethral plate for widening of urethral lumen and creation of neomeatus. Meatal stenosis may subsequently develop at new meatus and it is the limitation of this procedure. In this study TIPU procedure is modified by applying preputial skin graft on incised urethral plate in dorsal inlay fashion and outcome is evaluated. In this prospective study total 21 patients with distal penile hypospadias underwent repair between 2016 and 2017. TIPU urethroplasty was done as usual along with application of a preputial skin graft on midline incised urethral plate. Tubularization was done over appropriate sized catheter and double layers bilateral Dartos flap was applied to cover the suture line. SPC catheterization was done in every patient. On 14th post-operative day urethral catheter was removed and on the same day if patient voids satisfactorily, SPC catheter was also removed. The outcome was evaluated according to the Hypospadias Objective Scoring Evaluation (HOSE) system. 95.23% of the patients achieved apical neomeatus and 90.47% of slit like meatal shape. Mild degree chordee and normal caliber urinary flow was in 9.5% and 95.23% of the patients respectively. 4.76% of the patients developed urethrocutaneous fistula. Dorsal inlay preputial skin grafting is a very simple and feasible technique to maximize the outcome of TIPU procedure. However, multicenter and high volume data are needed for its wide application.
 Bangladesh Med J. 2018 Jan; 47 (3): 9-12

Megameatus Intakt Prepisyumda Glanuler Yaklaştırma Prosedürü: Olgu Serisi

Objective: The megameatus intact prepuce (MIP) is a rare type of hypospadias which is usually diagnosed during circumcision. In this study, it is aimed to present our experience with glanular approximation procedure (GAP) in the management of MIP. Material and Methods: A retrospective study of 13 patients with MIP variant of hypospadias who were repaired between September 2017 and April 2019 using GAP technique was performed. The total number of hypospadias cases during the study period was 85 and MIP cases constituted 15.3% of these patients. The surgical aims in GAP are to achieve a conical glans containing vertical slit, tip-cited meatus and a normal projectile urine flow. Results: The age range of the patients was between 18 months and 7 years. The locations of urethral meatus were glanular in 8 and coronal in 5. In all the cases, the neourethra was constructed using 7/0 polydioxanone (PDS)® in a subcuticular and uninterrupted fashion. Except for 5 patients with coronal meatus that an intermediate layer from nearby dartos fascia was interposed to support urethroplasty suture line, no intermediate layer was transposed between the tissue layers with two overlying suture lines. Good cosmetic result was obtained in all patients with a normal appearing conical glans penis. One patient developed urethrocutaneous fistula requiring surgical closure. Conclusion: The MIP is a simple form of hypospadias which sometimes may produce problems to surgeons. The GAP procedure is a simple technique with good cosmetic results producing patient satisfaction. Except for more severe MIP cases, GAP technique is useful in hypospadiac patients with MIP especially having glanular and coronal meatus.

Obstructive Uropathy in Children – An Update

Obstructive nephropathy is a structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction. Urinary tract obstruction can result from congenital (anatomic) lesion or can be caused by trauma, neoplasia, calculi, inflammation or surgical procedures, although most childhood obstructive lesions are congenital.The clinical features in most of the patients are due to consequences of the obstruction2. Obstruction of the urinary tract generally causeshydronephrosis, which is typically asymptomatic in its early phase. Renal USG gives information about urinary tract dilatation, renal cortical thickness, calyx size, diameter of pelvis, ureter, bladder thickness, tumor & calculi and doppler USG for evaluation of aberrentvessles. Once obstructive nephropathy has been identified therapy focuses on the rapid restoration of normal urine flow either by medical or surgical intervention.Bangladesh J Child Health 2017; VOL 41 (2) :117-124

Long-term urinary symptoms in adolescent and adult women with congenital adrenal hyperplasia

Congenital adrenal hyperplasia (CAH) is an autosomal recessive condition resulting in excess androgen production. Females are typically born with ambiguous genitalia and often undergo feminising genitoplasty in infancy or childhood. Recently, there has been considerable international debate as to whether distressing urinary symptoms in CAH patients are truly present and, if so, whether these urinary problems are a consequence of the feminising genitoplasty. To identify and assess any urinary symptoms in an Australian cohort of adolescent and adult women with CAH who have undergone feminising genitoplasty in infancy, childhood or adolescence as a part of their management. Females with CAH aged 12-40 years, who had undergone feminising genitoplasty, and were identified from a hospital database (n=72). Those aged 12-15 years were assessed using the Paediatric Incontinence Symptom Index questionnaire in conjunction with sections of the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Those aged 16-40 years were assessed using the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Uroflowmetry studies and post-void residual volume ultrasounds were also conducted. Previously published normative data were used for the control population. Responses to the questionnaire indicated that CAH patients had a higher incidence of urgency, frequency, urge incontinence, unexplained incontinence and nocturnal incontinence, when compared to previously published control data. Average and maximum urine flow rates measured by uroflowmetry were within normal range; however, the 16-40-year-old age group had significantly increased mean post-void residual volumes (P<0.001) (Summary table). The presence of lower urinary tract symptoms in these patients has previously been interpreted as a direct outcome of feminising genitoplasty; however, these results could also be accounted for by the virilisation of pelvic floor musculature. Androgens have been shown to increase skeletal muscle mass, but their exact impact on the pelvic floor musculature requires further research. Three previous studies have measured post-void residual volumes in patients with CAH, all of which found it them be raised. Patients with CAH appeared to have overall normal urinary flow but increased post-void residual volumes. The data suggested that this population of patients has an increased probability of incontinence, urgency, and frequency when compared to a control population. These results confirmed findings of other small studies; however, it remains unclear if these changes reflected the underlying diagnosis or were a consequence of management.

A Case of foreign body granuloma after Plastibell® circumcision

Male circumcision is one of the most commonly performed surgical procedures and the Plastibell® device is a popular method used to perform circumcisions in neonates and young children. We report a case of a 9-year-old otherwise healthy boy who developed foreign body granulomas following Plastibell® circumcision which was carried out in the community by a medically trained practitioner. His post-operative course was complicated by a retained Plastibell® ring and development of multiple non-healing wounds and granulomas. This patient underwent a semi-elective examination under general anesthesia, wound exploration and re-do modified circumcision. At 4 month follow up the wound was well healed without scarring and the patient reported a normal single straight stream urinary flow.

P 81 Voiding disorder – almond or walnut?

Introduction Limbic encephalitis is an inflammatory disease of the central nervous system. The subacute development of short-term memory deficit is typical of this disease, as are psychiatric symptoms and seizures. Limbic encephalitis is caused by auto -immunity and is associated with cancer in about 60 per cent of cases. Since 1999, several antibodies associated with limbic encephalitis have been identified. Case report A 74-year-old patient was referred to our hospital because of urinary retention (residual urine volume: 840 ml) and disorientation. In the previous 4 months, he had developed short-term memory deficit and gait disturbance. A neurological examination, showed, ataxic gait, dysmetria of the right arm and leg, light paresis for the ab-/adduction of the fingers and dorsal flexion of the foot, and pallanesthesia of the malleolus. Neurological nerve conduction studies, electromyography and ultrasound revealed signs of neuropathy with axonal and demyelinating damage. After prostate resection the urinary retention did not improve. The spinal MRI did not show any significant cervical or lumbar stenosis. Cerebrospinal fluid showed a monocytic pleocytosis and an elevated protein. Also, positive oligoclonal bands GABA-B-Rezepor antibodies were detected isolated in the cerebrospinal fluid. A diagnostic search for cancer including imaging (PET-CT) and various tumor markers was negative. After treatment with metylprednisolone (500 mg for 5 days) and prednisolone (1 mg per kg with tapering doses), and IVIG (2 g per kg body weight over 5 days and 1 g per kg body weight over 2 days every four weeks), there was a rapid improvement of the voiding disorder to restored normal urine flow. Also, a slow improvement of the short-term memory deficit and a stabilization of the gait disturbance. Summary In conclusion, we diagnosed a GABAB receptor positive limbic encephalitis with polyneuropathy and possible transverse myelitis. In our opinion, this has not been described before.

Role of Uttarabasti in the management of Functional Bladder Outlet Obstruction: A Case Study

Bladder outlet obstruction (BOO) produces compression or resistance upon the bladder outflow channel at any location from the bladder neck to urethral meatus. It may be induced by specific functional and anatomic causes. Functional obstruction may be caused by detrusor-sphincter dyssynergia (DSD) and anatomic obstruction most commonly from benign prostatic enlargement (BPH) or urethral stricture. Obstructive symptoms include hesitancy, sensation of incomplete bladder emptying, diminished urinary stream. The combination of PVR, urinary flow measures, and symptom appraisal has been generally accepted as the initial screening and evaluation paradigm for BOO. In, Ayurveda, BOO is similar to Mutraghata means obstruction in the urine flow. Uttarbasti is the prime treatment of Mutraghata. Present case is diagnosed as a functional bladder outlet obstruction (BOO) on the basis of symptoms, normal reports of USG and ascending urethrogram and diminished flow of urine in Uroflowmetry. Total 7 Uttarbasti with 50ml Sahcharadi Tailam was given along with Rasayana and Mutraghatahara medicine. Patient has complete relief in his obstructive urine complains and has normal urine flow without taking Tab. AFDURA after 7 years. And also improvement appear in Uroflowmetry.

Obstrução uretral aguda causada por tumor venéreo transmissível em um cão

Background: Transmissible venereal tumor (TVT) is a sexually transmitted, contagious, round cell neoplasm that affects mainly the external genital organs of dogs of both sexes. Canine TVT is practically the only tumor transmitted by cellular transplantation under natural conditions. The tumor occurs in all dog breeds and in various parts of the world, especially in the tropics and subtropics. Sexually active dogs that roam are at increased risk of acquiring the infirmity. The diagnosis is clinical, and confirmed by cytology. The most effective treatment is chemotherapy with vincristine. The aim of this report is describes a case of one male dog with an acute urethral obstruction caused by TVT.Case: In a Veterinary Medical Teaching Hospital (VMTH), a dog of unknown age was admitted. Volunteers from an animal protection institution rescued the dog from the streets after information from residents. Upon admission in the VMTH, the dog had an acute urethral obstruction, detected on clinical examination. Cystocentesis was performed to relieve the condition. Complete clinical examination and blood count were performed. Hematological examination revealed anemia and thrombocitopeny. The clinical examination revealed a swelling in the preputial area, and penile exposure was not possible. Because of this it was not possible to place the urethral catheter in the animal. However, preputial fistula and a friable, bleeding mass suggestive of a TVT were detected. For penile inspection and correction of the obstruction, the dog was submitted to a surgical procedure with an incision in the preputial midline. After the incision was made, several masses with a friable and bleeding appearance were found. The masses that prevented the urinary flow were removed and, cleansed with a physiological solution. The skin was sutured to restore the normal anatomy. In the same procedure, the dog was neutered. Cytological examination of the masses confirmed the diagnosis of TVT. After the surgery, the animal was treated with vincristine sulfate for three weeks and completely recovered. Due to the findings of the hemogram that were suggestive of hemoparasite, the animal was later referred for clinical investigation.Discussion: The animal in this case had lived on the streets, where it contracted TVT. This tumor is found most often in dogs that roam. The cystocentesis performed in the patient is used in cases of urethral obstruction in dogs where it is not possible to pass catheter. The friable and bleeding masses with ulceration that were presented by the animal, demonstrated macroscopic aspects characteristic of tumor venereal transmissible. In this type of neoplasm can appear masses in diverse places of the body, but in this dog, the masses were only in the genitalia. The urethral obstruction was caused by the masses around the urethral orifice, and urethral obstructions in dogs may be from neoplasms. The cytological examination confirmed the diagnosis, and such examination is adequate to diagnose TVT. The treatment with chemotherapy is effective to control the disease. However, in this animal, surgical intervention was necessary to restore normal urinary flow. The chemotherapy with vincristine was used after the surgical procedure to eliminate remaining masses. The animal was castrated because of the need for population control in free-living dogs. Although not common, urethral obstruction in dogs can be caused by tumor venereal transmissible.

LOWER URINARY TRACT DYSFUNCTION IN CHILDREN: FOCUS ON OVERACTIVE BLADDER

A disfunção do trato urinário inferior (DTUI) na infância apresenta alta prevalência, podendo levar a sintomas de urgência miccional, incontinência urinária, infecção do trato urinário, refluxo vesicoureteral, lesão renal, além de impactos psicoemocionais. A hiperatividade vesical (HV) é a forma mais comum de apresentação da DTUI, sendo caracterizada como uma alteração na fase de enchimento vesical, acompanhada por sintomas urinários próprios desta fase, mas com um padrão de fluxo urinário normal e sem apresentação de resíduo pós-miccional. A sua fisiopatologia ainda é controversa, e engloba possibilidades de alterações de origem central, de desencadeamento de contrações não inibidas do detrusor devido ao quadro de constipação intestinal, ou ainda a possibilidade de ser causada pelo quadro de infecção do trato urinário. Há três principais tratamentos disponíveis para tratar crianças com HV: medicação, uroterapia e eletroestimulação. Destes, a terapia medicamentosa ainda é a mais difundida pelo mundo, apesar de trazer diversos efeitos colaterais e baixa taxa de cura. A uroterapia é baseada em orientações miccionais e alimentares e deve ser indicada como a primeira linha terapêutica. A eletroestimulação ainda apresenta diversidade em relação à posição do eletrodo, tempo e frequência da aplicação e parâmetros diferentes em relação à corrente terapêutica. Apesar dessa variabilidade, as terapias combinadas da uroterapia com a eletroestimulação apresentam melhores resultados clínicos de acordo com os trabalhos disponíveis na literatura.

Prevalence of chronic prostatic inflammation based on clinical diagnostic criteria in a real-practice setting: a nation-wide observational study.

Chronic prostatic inflammation has a key role in the pathogenesis and progression of benign prostatic hyperplasia (BPH). Thus, the identification of patients with chronic inflammation is mandatory for Urologists. This study investigates which clinical, imaging and laboratory findings are used by Urologists in clinical practice to diagnose BPH and chronic prostate inflammation. This was a multicenter, non-interventional, observational study involving 30 Italian large-volume primary care urology centers. Patients were allocated into four diagnosis group: patients with BPH; patients with BPH and chronic prostate inflammation; patients with chronic prostate inflammation alone; and patients with lower urinary tract symptoms (LUTS) due to other causes. In total, 6134 patients were enrolled. BPH diagnosis with or without concomitant prostate inflammation was more frequent in older patients, while inflammation alone was prevalent in younger patients. Predictive factors for diagnosis of inflammation in all patients, regardless of age, were normal urinary flow (OR=2.73) and proved in-fection (OR=5.90), while in older patients (>61 years) diagnosis of chronic prostatic inflammation was specifically predicted by higher PSA values (≥4 ng/mL; OR=2.91), normal prostate volume (OR=10.23), mild symptoms (IPSS <8; OR=1.84), presence of intraprostatic calcifications (OR=4.55), and the combination of both infection and calcifications (OR=10.79). In daily practice, the presence of chronic prostatic inflammation is underestimated. A stricter application of established diagnostic criteria suggested would increase the detection rate of chronic prostatic inflammation and potentially change the therapeutic approach in many patients with LUTS.