Presence Of Residual Urine Research Articles

Physico-biochemical parameters of urine and blood and biominerology of urinary bladder stones in patients with bladder outlet obstruction

BACKGROUND: Bladder outlet obstruction is one of the main factors leading to the formation of stones in the urinary bladder. Understanding of the physico-biochemical processes in urine and blood, as well as the biomineralogy of urinary bladder stones, will make it possible to determine the pathogenetically justified treatment of such patients.
 AIM: The aim of the study was to identify and study the relationship between the physico-biochemical parameters of urine and blood and the biomineralogical composition of urinary bladder stones in patients with bladder outlet obstruction.
 MATERIALS AND METHODS: A comprehensive examination of 76 patients at the age of 37 to 89 years with urinary bladder stones occurred against the background of bladder outlet obstruction was carried out. A comprehensive diagnosis, including an assessment of the physico-biochemical parameters of urine and blood, bacteriological urine tests, radiological diagnostics, as well as biomineralogical studies of concretions, was carried out.
 RESULTS: The data obtained show that not all physicochemical parameters of blood and urine of the subjects are comparable with the data of patients with nephrolithiasis. In the vast majority of the studied kidney calculi were not detected, in addition, blood biochemical parameters, including the level of stone-forming substances were within the reference values. In urine tests an increase in some lithogenic substances is detected. Urinary stones in patients with bladder outlet obstruction had a mixed composition, more often phosphates and uric acid salts were detected (75 and 54% of cases, respectively). Considering the nature of metabolism and the increase in uric acid excretion with age, as well as the presence of residual urine in case of bladder outlet obstruction, it can be assumed that uric acid is the primary matrix in cystolithiasis. The data obtained indicate a connection between the infectious process in the bladder and the composition of urinary stones. Against this background, there is a more intensive process of cystolithogenesis.
 CONCLUSIONS: The algorithm for the diagnosis of urinary bladder stones secondary to bladder outlet obstruction should include not only the collection of anamnesis and the performance of routine blood and urine tests, but also specific physical and biochemical studies, as well as assess the biomineralogy of urinary stones, which will make it possible to choose an adequate tactics for the pathogenetic treatment of patients and effective metaphylaxis of stone formation.

Аналіз факторів дожиття до замісної ниркової терапії пацієнтів з хронічною хворобою нирок

Актуальність. Відношення між хронічною хворобою нирок (ХХН) і кардіоваскулярними захворюваннями (КВЗ) є важливими та комплексними і характеризуються наявністю численних несприятливих чинників порівняно з хворими з самостійними КВЗ. Мета дослідження: оцінити частоту факторів кардіоваскулярного ризику серцево­судинних ускладнень, нефрологічних факторів ризику та їх комбінацію у пацієнтів з ХХН IV–V ст., які дожили до етапу замісної ниркової терапії. Матеріали та методи. Ретроспективно проаналізовано медичну документацію (упродовж 2 років) 42 хворих (чоловіків — 12 (28,6 %), жінок — 30 (71,4 %)) на ХХН IV–V стадії, які на час проведення аналізу медичної документації не отримували замісну ниркову терапію. Усім хворим розраховували індекс маси тіла (ІМТ), визначали артеріальний тиск (АТ), частоту серцевих скорочень (ЧСС), оцінювали показники загального та біохімічного аналізу крові та сечі, визначали рівень залишкового діурезу. У всіх хворих обчислено швидкість клубочкової фільтрації (ШКФ) за формулою CKD­EPI. Статистична обробка матеріалів дослідження — пакет програм Statistica v.6.1 (Statsoft Inc., США). Результати. Середній вік пацієнтів становив 47,6 ± 11,6 року. Отримані дані засвідчили, що хворі на ХХН, які дожили до замісної ниркової терапії, мали добовий діурез понад 500 мл, ЧСС менше 90 уд/хв, рівень систолічного АТ у таких пацієнтів підтримувався медикаментозно на рівні менше 160 мм рт.ст., також характерною ознакою був рівень загального холестерину (ЗХС) крові ≥ 4,5 ммоль/л та ІМТ понад 25 кг/м2. Нами був виявлений прямий кореляційний зв’язок між рівнем ШКФ та рівнем ЗХС крові (r = 0,32, р = 0,04); між ШКФ та рівнем гемоглобіну крові (r = 0,39, р = 0,01) і прямий кореляційний зв’язок між ШКФ і кількістю залишкової сечі у обстежених хворих (r = 0,32, р = 0,04). Висновки. Найбільш вагомими чинниками доживання хворого на ХХН до замісної ниркової терапії є молодий вік (до 40 років), наявність залишкової сечі (добовий діурез понад 500 мл/добу), відсутність цукрового діабету. Велику роль відіграє контроль систолічного АТ < 160 мм рт.ст. та анемії.

One-stage buccal two-flap urethroplasty using the Kulkarni technique for extended anterior urethral strictures

Introduction. The problem of extended urethral strictures treatment remains relevant due to the complexity of the supervision of such patients and the high frequency of disease recurrence after surgical treatment.Purpose of the study. Evaluation of the effectiveness of one-stage buccal urethroplasty according to the Kulkarni technique using two flaps for extended anterior urethral strictures.Materials and methods. The study included 18 men with an extended anterior urethral stricture, who underwent buccal urethroplasty by perineal access using the Kulkarni dorsolateral onlay technique using two flaps from January 2018 to March 2020, and a postoperative follow-up period of at least 6 months. The study was prospective. Control examination was carried out 3, 6, 12, 18 and 24 months after surgery. The criteria for the recurrence of urethral stricture were the presence of complaints of deterioration in the quality of urination in combination with a decrease in the maximum urinary flow rate of less than 12 ml/sec and the presence of residual urine in an amount of more than 100 ml, as well as the need to perform any surgical intervention to restore the normal passage of urine.Results. The age of the patients ranged from 32 to 72 years (median 58 years). The length of the stricture ranged from 6 to 11 cm (median, 8 cm). The stricture was localized in the penile segment in 11 (61.1%) cases and the penile and bulbar urethra in 7 (38.9%) cases simultaneously. An iatrogenic cause of urethral stricture occurred in 11 (61.1) patients, idiopathic in 5 (27.8%) patients and inflammatory in 2 (11.1%) patients. The stricture was primary in 12 (66.7%) cases and recurrent in 6 (33.3%). Spontaneous urination was preserved in 6 (33.3%) patients, cystostomy existed in 12 (66.7%) patients. The follow-up period after surgery ranged from 3 to 24 months (median - 12 months). Recurrence of urethral stricture was noted in 3 (16.7%) cases. The use of this technique for recurrent forms of the urethral stricture (recurrence after the previous urethroplasty) is the most significant risk factor for treatment failure. 1 (5.6%) case of erectile dysfunction and stress urinary incontinence has taken place of the late postoperative complications.Conclusions. The Kulkarni operation using two buccal flaps for extended strictures of the anterior urethra allows to achieve high rates of efficacy and safety of a treatment, however, the risk of failure increases significantly when used for the treatment of recurrent types of strictures.

IJU this issue

This issue contains 15 Original Articles, three of which are excellent prospective clinical trials, and one Urological Note. Cabozantinib is a multiple receptor tyrosine kinase inhibitor targeting MET (c-MET), VEGFR2, RET, AXL, KIT and TIE-2. In the phase III, randomized, open-label METEOR study, cabozantinib was associated with a significant progression-free survival benefit and a greater objective response rate versus everolimus in patients with metastatic renal cell carcinoma who had progressed after VEGFR-TKI. Tomita et al. (Niigata, Japan) carried out a bridging study to METEOR to evaluate the efficacy and safety of cabozantinib in Japanese patients. This phase II, open-label, single-arm study showed that cabozantinib provided clinical benefits in Japanese patients with renal cell carcinoma, with similar efficacy and safety to the non-Japanese population. Medical lasers are increasingly used to treat benign prostatic hyperplasia. Shoji et al. (Isehara, Japan) carried out a randomized prospective study to compare functional outcomes and complications over a period of 12 months in benign prostatic hyperplasia treated with thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate. This study showed that thulium laser enucleation of the prostate is superior to bipolar transurethral resection of the prostate in resected volume, resected rates per prostate volume and transition zone volume, hemostasis, catheterization and hospitalization time, and decrease in prostate-specific antigen. However, excessive laser irradiation time in thulium laser enucleation of the prostate has the possibility to delay improvement of overactive bladder symptoms and decrease sexual function. Loose seeds and stranded seeds are available for low-dose rate brachytherapy. Each method has its own advantages and disadvantages, such as flexibility and fixation. Tanaka et al. (Kashihara, Japan) carried out a randomized controlled trial to compare the post-implant dosimetric parameters between the conventional method (using only the loose seeds) and the hybrid method. This study showed that the hybrid method of low-dose rate brachytherapy can achieve a higher coverage of the periprostatic region compared with the conventional method, while maintaining an acceptable level of urethral and rectal doses. The intravesical recurrence rate after transurethral resection of bladder tumor carried out for non-muscle-invasive bladder cancer (NMIBC) is high, and some risk factors for recurrence have been identified. Sazuka et al. (Chiba, Japan) evaluated the risk of the residual urine volume and preoperative pyuria in intravesical recurrence after transurethral resection of bladder tumor among NMIBC patients. They found that the presence of residual urine and pyuria raised the risk of intravesical recurrence after transurethral resection of bladder tumor for NMIBC. Furthermore, especially in men, the recurrence-free survival was significantly higher in patients without than with residual urine by propensity score matching analysis. Iwasawa et al. (Tokyo, Japan) investigated the relationship between fluid intake and tumor recurrence in NMIBC patients by using urine-specific gravity as an indicator of daily fluid intake. They found that high urine-specific gravity was associated with tumor recurrence, especially in patients not receiving adjuvant bacillus Calmette–Guérin therapy. This showed that increasing fluid intake might prevent recurrence in relatively low-risk NMIBC patients. Testicular microlithiasis (TM) is a relatively rare condition occurring in the testicular parenchyma that is characterized by multiple bright and small foci without acoustic shadow limited to the testicle on scrotal ultrasonography. TM is a characteristic of testicular dysgenesis syndrome and was shown to be associated with infertility. Hiramatsu et al. (Tokyo, Japan) evaluated the correlation between the degree of severity in TM and several factors. This study showed the prevalence of TM in normal healthy Japanese men who are trying for first-time pregnancy. This also showed that men with TM might have poor semen findings, and that men with severe TM might have even worse semen parameters. None declared.

Relationship between post-void residual urine volume, preoperative pyuria and intravesical recurrence after transurethral resection of bladder carcinoma.

To evaluate the relationship between residual urine volume, pyuria and bladder carcinoma recurrence. The clinical data of 305 patients who had post-void residual urine volume measured and preoperative pyuria were retrospectively collected. The patients were classified into three risk groups based on the presence of residual urine and pyuria: good (negative residual urine and pyuria), intermediate (positive residual urine or pyuria) and poor (positive residual urine and pyuria). Predictive factors for intravesical recurrence-free survival were statistically analyzed using Cox proportional hazard models and Kaplan-Meier methods. The propensity score matching method was used to adjust the patients' backgrounds. The median follow-up period for all patients was 44months. The presence of residual urine (P=0.0164) and pyuria (P=0.0233) were two independent prognostic factors for recurrence. After patients were classified into risk groups, the poor-risk group showed significantly shorter recurrence-free survival compared with that of the good- (P=0.0002) and intermediate-risk groups (P=0.0090). Even after matching, the presence of residual urine was related to short recurrence-free survival in male patients (P=0.0012). When stratified by European Organization for Research and Treatment of Cancer risk groups, the presence of pyuria was related to short recurrence-free survival, especially for intermediate-risk patients without bacillus Calmette-Guérin treatment. Post-void residual urine and preoperative pyuria are two risks for recurrence-free survival in non-muscle-invasive bladder cancer.

Male sex and anterior wall tumor location as risk factors for urinary dysfunction after laparoscopic rectal surgery.

Total mesorectal excision (TME) has decreased the local recurrence rate and improved the overall survival of rectal cancer patients. However, urinary dysfunction remains a clinical problem after rectal cancer surgery. The aim was to assess the risk factors for postoperative urinary dysfunction. This study was a single-center, retrospective analysis of 104 patients who underwent laparoscopic rectal surgery between November 2016 and October 2017. Postoperative urinary dysfunction was defined as the need for urinary catheter re-insertion or the presence of residual urine (≥ 150mL) postoperatively. Postoperative urinary dysfunction was seen in 18 patients (17%). Multivariate analysis showed that male sex (odds ratio 3.89, p = 0.034) and anterior wall tumor location (odds ratio = 4.07, p = 0.037) were the predictors of postoperative urinary dysfunction. Compared with patients without risk factors, those with the two risk factors needed longer hospital stays (16days vs. 30days, p = 0.0022). Male sex and anterior wall tumor location were the risk factors for urinary dysfunction after laparoscopic rectal surgery.

Осложнения гольмиевой лазерной энуклеации гиперплазии предстательной железы

With growing experience in the HoLEP, it can replace TURP as the "gold standard" for the surgical management of BPH, and therefore this technique is the most studied surgical modality. Despite the proven effectiveness of HoLEP in the treatment of patients with BPH, its widespread use has been associated with both intra- and postoperative complications. To improve the results of surgical management of patients with BPH. The study comprised 310 patients who underwent HoLEP for BPH. HoLEP was performed using the Gillings technique. presence of LUTS (Qmax<15 ml/s, Qav<10 ml/s, presence of residual urine, I-PSS score> 5, QoL score> 2), absence of an active inflammatory process of the urogenital organs. Intraoperative complications included severe hemorrhage in 16 (5.2%), the bladder wall injury in 17 (5.5%) and the ureteral orifice injury in 2 (0.6%) patients. 275 (88.7%) had no intraoperative complications. Early postoperative complications included fever in 4 (1.3%), the bladder tamponade that required cystoscopy and evacuation of blood clots in 7 (2.3%) and acute urinary retention in 36 (11.8%) patients. 263 (84.6%) patients had no postoperative complications. Long-term postoperative complications comprised urinary incontinence in 39 (12.6%) patients and urethral strictures requiring surgical treatment in 9 (2.9%) patients. There were no long-term complications in 262 (84.5%) patients. HoLEP is an effective and safe surgical modality for treating patients with BPH with minimal complications, suitable for any size of the prostate.

Health-related quality of life, depression and mortality in peritoneal dialysis patients in Turkey: seven-year experience of a center

Introduction: Impairment of health-related quality of life (HRQoL) and being in a depressive mood were found to be associated with increased mortality in peritoneal dialysis (PD) patients. We aimed to investigate the association between HRQoL, depression, other factors and mortality in PD patients. Materials and methods: Totally 171 PD patients were included and followed for 7 years in this prospective study. Results: Of 171 PD patients, 45 (26.3%) deceased, 18 (10.5%) maintained on PD, 87 (50.9%) shifted to hemodialysis (HD) and 21 (12.3%) underwent transplantation. The most common cause of death was cardiovascular disease (32, 71.1%) followed by infection (6, 13.3%), cerebrovascular accident (5, 11.2%). The etiology of patients who shifted to HD was PD failure (41, 47.1%), peritonitis (33, 37.9%), leakage (6, 6.9%), catheter dysfunction (3, 3.4%), self willingness (4, 4.6%). Non-survivors were older than survivors (56.6 ± 15.0 vs. 43.6 ± 14.6, p = 0.003). There were also statistically significant difference in terms of albumin, residual urine, presence of diabetes and co-morbidity. When the groups were compared regarding HRQoL scores, non-survivors had lower physical functioning (p < 0.001), role-physical (p = 0.0045), general health (p = 0.004), role-emotional (p = 0.011), physical component scale (PCS) (p = 0.004), mental component scale (MCS) (p = 0.029). Age, presence of residual urine, diabetes, albumin, PCS and MCS were entered in regression analysis. Decrease of 1 g/dL of albumin and being diabetic were found to be the independent predictors of mortality. Conclusions: Diabetes and hypoalbuminemia but not HRQOL scores were associated with higher mortality in PD patients after 7 years of following period.

Bladder stones in acute spinal cord injury

Urologic complications are an important cause of morbidity and even mortality in patients with spinal cord injury (SCI). It has been estimated that within eight years after injury, approximately 7% of SCI patients would develop kidney stones, whereas 36% would have bladder stones. Risk factors for urolithiasis among patients with SCI include complete spinal cord injury, lesions at or above the 4th thoracic spinal cord segment, upper motor neurone type of bladder, urinary tract infection with urease producing bacteria, recurrent urinary tract infection, indwelling catheters, presence of residual urine and immobilization. Detection and removal of bladder stones are important to prevent possible complications such as recurrent urinary tract infection, urosepsis and renal failure. The authors describe a clinical case of a patient with acute SCI that developed bladder stones and discuss its possible causes.

Marked hydronephrosis and hydroureter after distigmine therapy in an adult male patient with paraplegia due to spinal cord injury: a case report

IntroductionDistigmine, a long-acting anti-cholinesterase, is associated with side effects such as Parkinsonism, cholinergic crisis, and rhabdomyolysis. We report a spinal cord injury patient, who developed marked hydronephrosis and hydroureter after distigmine therapy, which led to a series of complications over subsequent years.Case presentationA 38-year-old male developed T-9 paraplegia in 1989. Intravenous urography, performed in 1989, showed normal kidneys, ureters and bladder. He was prescribed distigmine bromide orally and was allowed to pass urine spontaneously. In 1992, intravenous urography showed bilateral marked hydronephrosis and hydroureter. Distigmine was discontinued. He continued to pass urine spontaneously.In 2006, intravenous urography showed moderate dilatation of both pelvicalyceal systems and ureters down to the level of urinary bladder. This patient was performing self-catheterisation only once a day. He was advised to do catheterisations at least three times a day. In December 2008, this patient developed haematuriawhich lasted for nearly four months.. He received trimethoprim, then cephalexin, followed by Macrodantin, amoxicillin and ciprofloxacin. In February 2009, intravenous urography showed calculus at the lower pole of left kidney. Both kidneys were moderately hydronephrotic. Ureters were dilated down to the bladder. Dilute contrast was seen in the bladder due to residual urine. This patient was advised to perform six catheterisations a day, and take propiverine hydrochloride 15 mg, three times a day. Microbiology of urine showed Klebsiella oxytoca, Pseudomonas aeruginosa, and Enterococcus faecalis. Cystoscopy revealed papillary lesions in bladder neck and trigone. Transurethral resection was performed. Histology showed marked chronic cystitis including follicular cystitis and papillary/polypoid cystitis. There was no evidence of malignancy.ConclusionDistigmine therapy resulted in marked bilateral hydronephrosis and hydroureter. Persistence of hydronephrosis after omitting distigmine, and presence of residual urine in bladder over many years probably predisposed to formation of polypoid cystitis and follicular cystitis, and contributed to prolonged haematuria, which occurred after an episode of urine infection. This case illustrates the dangers of prescribing distigmine to promote spontaneous voiding in spinal cord injury patients. Instead of using distigmine, spinal cord injury patients should be advised to consider intermittent catheterisation together with oxybutynin or propiverine to achieve complete, low-pressure emptying of urinary bladder.

The neurogenic bladder: introducing four contributions

Neurogenic bladder dysfunction in children is frequently seen in patients with meningomyelocele (MMC). The disorder carries a high risk for all kinds of complications, with renal damage being the most important. More than 95% of MMC patients have a neurogenic bladder, the paramount manifestation of which is a disturbed coordination between detrusor and sphincter muscles. This vesicourethral dysfunction leads to defective filling and emptying of the urinary bladder. Voiding at will is almost never possible. According to the location and extent of the neural tube lesion, patients have either an atonic or a hypertonic pelvic floor and either an atonic or a hypertonic detrusor, leading to four classic combinations. Hypertonic sphincter and detrusor hyperactivity lead to the most dangerous form of neurogenic bladder, referred to as the "unsafe" bladder. The presence of residual urine in a high-pressure container causes either decompensation of the detrusor with vesicoureteral reflux or deterioration of the bladder wall with hypertrophy and stiffness resulting in uterovesical obstruction. The subsequent insufficient drainage of the upper urinary tract leads to decompensation of the ureters and finally to chronic renal disease, the process being accelerated by urinary tract infections. The aim of treatment is to restore as much as possible both essential functions: urine storage and timely emptying of the reservoir. What should and can be achieved is a more or less adequate, low-pressure, functional capacity of the bladder that is emptied as completely as possible by clean intermittent catheterization (CIC). MMC leads to the prototype of neurogenic bladder in childhood. What we know and what we do for MMC patients can roughly be applied to all other forms of neurogenic bladder, either congenital or acquired.

Role of angiogenesis in bladder response to partial outlet obstruction

Benign prostatic hyperplasia (BPH) is a disease that has its etiology in the abnormal growth of the adult human prostate gland that accompanies the aging process in men. The symptomatic presentation of this disease, however, is related largely to degenerative changes in the bladder that occur as a result of the increasing urethral resistance and partial bladder outlet obstruction (PBOO) caused by the growing prostate gland. BPH is characterized by bladder hypertrophy, significant decreases in urinary flow and compliance, presence of residual urine after voiding, voiding urgency and incontinence (). Obstructed bladder dysfunction secondary to BPH is a slow, progressive disease that is so strongly associated with human aging that it is an expected occurrence of the male aging process. Although the symptoms of BPH are usually not life threatening, they effect an extremely negative quality of life for men who suffer from them. However, many men delay seeking medical treatment for early BPH since bladder function can remain relatively normal as the hypertrophying bladder initially compensates for the progressive increase in urethral resistance caused by prostatic obstruction. The limited changes in micturition pressure and flow characteristics that occur during compensated function are not usually disabling enough to motivate seeking medical attention, which, often, is not sought until the symptoms become typical of advanced disease. Recent advances in detection methods enable identification of patients with significant BPH during compensation before the bladder becomes dysfunctional (decompensated). A more complete understanding of the disease processes that underlie the loss of bladder function associated with BPH might enable the development of treatments that better protect these early-stage BPH patients from the more debilitating aspects of the disease. This review updates the understanding of obstructive bladder dysfunction via the use of animal models.

Ultrasonic Assessment of Residual Urine Volume

The assessment of residual urine forms an essential part of the investigation of many urological patients, particularly those with suspected urinary outflow obstruction; the presence of residual urine may influence their management. Generally, it is necessary to measure the volume of residual urine to assess bladder function. The advantages of establishing a simple non-invasive method to measure bladder volume have long been recognized. Various methods of assessing residual urinary volumes exist, including abdominal palpation, the use of postvoiding films from excretory urography and excretion tests using phenolsulphaphtalein or radiolabeled compounds. The most commonly used and accurate technique, catheterisation of the bladder, has the risk of introducing infection and traumatizing the urethra. A method to assess residual urine that is simple, safe, easily repeatable, non-invasive and accurate would be considerable value in clinical practice. in our study we compared the ultrasonically measured residual volumes measured by catheterisation. We describe an ultrasound method for the measurement of residual urine that is quick, easy to perform, accurate and causes no discomfort to the patient.

Detrusor/sphincter dyssynergia in neurologically normal children

AbstractFor 143 boys and girls without overt neuropathy, the occurrence of urethral overactivity during voiding (detrusorkphincter dyssynergia) has been investigated in three cystometrically recorded micturitions and a free‐flow measurement. The following aspects have been statistically examined for their reproducibility and consistency in reflecting urethral over‐activity: the pressure/flow relationship, the pelvic‐floor EMG, residual urine, and the freeflow curve. Any single aspect, or any single micturition (even the free‐flow measurement), suggests an unrealistically high incidence of “dyssynergia.” By combining them, however, we have developed a concept of consistent urethral overactivity, which is associated with residual urine, appears to be clinically significant, and has an incidence of 19% in our material. Consistent urethral overactivity has a significantly higher incidence (67%) in children with upper‐tract disease on both sides, suggesting a causative role. In girls, there is a spectrum of dysfunction, ranging from a more serious type, reflected in the presence of residual urine and of consistent urethral overactivity, to a relatively trivial type, without residual urine, associated principally with an abnormally high EMG during voiding and with a history of urinary tract infections. In our material, there is no association between urethral overactivity during voiding and detrusor instability during bladder filling, suggesting that these are two unrelated findings and not two aspects of a single syndrome.

Ultrasonographic determination of residual urine in diabetic subjects: relationship to neuropathy and urinary tract infection.

The presence of residual urine was determined by postvoid bladder ultrasonography in 37 control subjects and 102 unselected insulin-dependent and non-insulin-dependent diabetic patients. Significant residual volume was detected in 19 diabetic subjects without explanation other than diabetic neurogenic bladder dysfunction in 15. The four others had prostatic hypertrophy. Excluding these four subjects, those with residual urine were slightly older than the others (P less than 0.05), but the known duration of diabetes was increased only for the insulin-dependent group (P less than 0.05). The presence of residual urine was strongly associated with peripheral neuropathy (P less than 0.001). In contrast, of all the manifestations of autonomic failure studied, only impotence (P less than 0.01) and decreased pupil motility (P less than 0.05) were associated with residual urine. The prevalence of urinary tract infection was higher in women than in men (P less than 0.02). This prevalence was increased in the presence of residual urine (P less than 0.02) but only for men (P less than 0.001).

Asymptomatic bacteriuria in schoolgirls. III. Relation between residual urine volume and recurrence.

Residual urine volume (RUV) has been measured in 70 schoolgirls with asymptomatic bacteriuria using 121I-hippuran. The mean volume of residual urine was 23.7 ml. More than 5 ml RUV, the highest value found in 14 girls without bacteriuria or a history of urinary tract infection, was found in 47% of the patients. The mean volume for residual urine in the control girls was 1-1 ml. Among the 44 girls cured for their bacteriuria be a bladder wash out test or antibiotic treatment, recurrence was significantly more common (p less than 0.001) in those greater than 5 ml in RUV (45/20, 75%) than in those with less than or equal to 5 ml (4/24, 17%). In 5 of 22 patients not treated, the bacteriuria disappeared spontaneously during a one year observation period. The RUV was less than 3 ml in 4 of these 5 girls. While the presence of residual urine per se may not be the primary event leading to bacteriuria, it may increase the risk of recurrences, by facilitating bacterial growth and impairing the wash out of bacteria from the bladder on micturition.

Prostatic hyperplasia;common misconceptions.

Gross misconceptions are prevalent regarding symptoms and the results of urologic investigation and surgical treatment of prostatic hyperplasia.All patients with prostatism do not have significant urinary symptoms. The importance of the absence or the presence of residual urine also has been misinterpreted. The impression that future prostatic hyperplasia or carcinoma is precluded by prostatectomy but possibly will occur following transurethral resection is erroneous.The physician also must realize that pyuria may exist for several months after prostatectomy has been performed.

The aetiology and treatment of diverticulum of the bladder.

SUMMARY One hundred and five cases of vesical diverticulum are analysed. The ætiology is discussed, and it is suggested that urethral obstruction and bladder‐wall hypertrophy exist in all cases. It is suggested that congenital bladder‐neck obstruction is the obstructing factor. The mechanics of formation and enlargement of a diverticulum are considered, and it is suggested that the pouch always enlarges and remains within the layers of the bladder wall. The indications for treatment are discussed, and it is suggested that the presence of residual urine in the diverticulum is the only reliable indication for operation. Operative details are considered and an alternative and simpler operation is described. Urinary infection, calculus. carcinoma of the bladder and renal failure are considered as to their effect on treatment.

THE BLADDER POST PARTUM

For several years, we have followed a definite routine when caring for the urinary bladder post partum. This paper is concerned with an outline of this care, and a review of obstetric conditions that may influence the behavior of the bladder during the puerperium. Our care of the urinary bladder post partum is based on the principles that overdistention of the bladder, and the presence of residual urine, favor infection of the urinary tract. We recognize a small group of women who are unable to void spontaneously post partum, apparently from no demonstrable cause. Nervous inhibition, posture and decreased intra-abdominal pressure may explain this. In caring for these patients, as well as all others, an attempt is made to cause spontaneous urination by such means as warm external pitcher douches. However, these are not persisted in to the point of exhausting the patient. We believe that too great value may