Spontaneous Micturition Research Articles

Predictive factors for the success of trial without catheter for men with urinary retention.

To investigate the trial of spontaneous urination without catheter (TWOC) outcomes for men with acute urinary retention, determine successful TWOC predictors, and evaluate the impact of add-on medication therapy on TWOC. This retrospective study included men with acute urinary retention and post-void residual (PVR) >250 mL who underwent TWOC between July 2009 and July 2019. Patients were divided into a medicated group who received alpha1 blocker on urinary retention diagnosis and a naïve group who did not. The trial was defined as unsuccessful if the PVR was >150 mL or if the patient experienced difficulty emptying their bladder with abdominal discomfort or pain, and a transurethral catheter was reinserted. Among 576 men with urinary retention, 269 (46.7%) constituted the medicated group and 307 (53.3%) the naïve. The naïve group comprised more elderly patients (P = 0.010) with higher Eastern Cooperative Oncology Group performance status (PS) (P = 0.001) and smaller prostate volume (P = 0.028) than the other. In the medicated group, 153 men received additional oral medication before TWOC to increase the success rate. There were significant age differences (P = 0.041) in the medicated group and significant median PS differences (P = 0.010) in the naïve group between the successful and unsuccessful outcomes of TWOC. The multivariate logistic regression model demonstrated that age <80 years in medicated patients (P = 0.042, odds ratio [OR] 1.701) and PS <2 in naïve patients (P = 0.001, OR 2.710) were significant independent predictors of successful TWOC outcomes. This is the first study classifying patients with urinary retention according to medication status. Both medicated and naïve groups had different patient backgrounds and TWOC outcome predictors, suggesting a discrepant etiology behind urinary retention. Hence, acute urinary retention management in men should vary based on medication status for male lower urinary tract symptoms when urinary retention is diagnosed.

Clinical effect of magnetic compression anastomosis on ureterostenosis after kidney transplantation.

Clinical effect of magnetic compression anastomosis on ureterostenosis after kidney transplantation.

Comparing Spinal Chloroprocaine to Hyperbaric and Isobaric Bupivacaine for Total Hip and Knee Arthroplasties: A Retrospective Study.

Spinal anesthesia is commonly used for total knee and hip arthroplasties (TKA/THA). The rising popularity of ambulatory TKA and THAs require anesthetic techniques that provide rapid recovery of motor and sensory function while minimizing side effects like postoperative urinary retention. This single-center retrospective observational study compares the recovery profile of patients undergoing TKA and THA under chloroprocaine spinals compared to hyperbaric and isobaric bupivacaine spinals. One hundred and twelve patients undergoing primary TKA and THA under spinal anesthesia at University of Florida Health were identified between September 1, 2019 and February 21, 2020. Their electronic medical records were reviewed. Patients were categorized based on the local anesthetic used in the spinal. Various demographic, intraoperative, and postoperative data were compiled and compared, including duration of surgery, time to physical therapy, time to post-anesthesia care unit (PACU) discharge, and time to spontaneous micturition. Timeto spontaneous micturition and PACU discharge were significantly lower in the chloroprocaine spinal group compared to the hyperbaric bupivacaine group by 193 minutes and 42 minutes, respectively. Fewer patients receiving chloroprocaine spinals had their first physical therapy session limited by residual motor weakness compared to those in both bupivacaine groups. Additionally, mean duration of surgery was shorter in the chloroprocaine group compared to both bupivacaine groups (89 minutes compared to 111 minutes). Time to physical therapy completion was not different. All groups had <10% conversion to general anesthesia. Chloroprocaine spinals can be feasible options for TKAs and THAs with improved postoperative recovery profiles compared to bupivacaine spinals.

Penetrating gunshot wounds to the penis: a case report of combat patient injured in the war in Ukraine

BackgroundThe current war in Ukraine is associated with frequent applications of multiple-launch rocket systems and cruise missiles as well as other various high-energy weapons to cause severe injuries in military personnel including abdomen wounds, vascular injury, and limb amputations as well as genitourinary trauma. The aim of this report is to demonstrate a case of successful penile salvage by restoring its function in a combat patient with gunshot genitourinary trauma in conditions of an interrupted supply of medical equipment.Case presentationWe describe a case of a 48-year-old male patient with a combined shrapnel gunshot wound to the penis with damage to the urethra and combined injury to the soft tissues of the left thigh. Several hours after the injury, the patient underwent primary surgical debridement of the left thigh, ligation of the great saphenous vein of the thigh, primary sutures on the penile urethra and navicular fossa, suturing of the rupture of the head and penis, drainage of the wound, catheterization of the bladder, and epicystostomy. An artificial erection was performed intraoperatively.The urethral catheter was removed 3 weeks after urethral suturing (May 4, 2022). The epicystostomy was removed 5 months after the injury (August 4, 2022) and 2 days after the restoration of spontaneous urination. At the follow-up of 7 months after the injury, the patient has normal urination with minor urinary dribbling, sufficient erection, and ejaculation.ConclusionsWe have shown that in a case of gunshot wounds to the penis and hanging part of the urethra, even in the presence of combined severe purulent lesions of non-urological localizations, it is possible to perform a primary reconstruction of urogenital injuries using a primary urethral suture and applying a negative pressure device. Findings from this case report shed new light on the management of penile gunshot injury in ongoing warfare as well as provide evidence of the possibility to perform adequate management for penile injury in conditions of limited medical resources, violation of international humanitarian law, and under frequent strikes of high-energy weapons.

Multi-stage surgery for anterior urethral strictures: assessment of immediate and long-term surgical outcomes

BACKGROUND: The progress made in reconstructive urethral surgery over the past 20 years has shown the effectiveness of one-stage repair of anterior urethral strictures. Nevertheless, multi-stage urethroplasty retains its primary role in the treatment of patients with the most complex urethral narrowing and obliterations.&#x0D; AIM: To evaluate the immediate and long-term surgical results of multi-stage urethroplasty for penile and bulbar urethral strictures.&#x0D; MATERIALS AND METHODS: The study included 110 men aged 1884 years who underwent multi-stage urethroplasty for the anterior urethral structures in 20102019. The techniques of buccal and skin augmentation or urethral replacement plastics were applied. Before surgery, all patients underwent a standard urological examination. Early surgical complications were evaluated from medical records. Late surgical complications were determined according to examinations that included symptomatic assessment with specialized questionnaires, laboratory tests of serum and urine, physical examination, uroflowmetry, and retrograde urethrography and ureteroscopy (if urinary disorders were detected). The median follow-up was 5 years and 2 months.&#x0D; RESULTS: Early surgical complications were detected in 27 (24.5%) patients. Surgical interventions to resolve them were required in 7 (31.8%) cases: urethrocutaneous fistulas (5), acute urinary retention (1), scrotal hematoma (1). Late surgical complications were detected in 33 (30.0%) patients, including 29 (26.7%) cases of recurrent urethral strictures. All late complications cases were classified as Clavien-Dindo IIIb, and a total of 49 additional operations were performed to eliminate them. The primary success rate for multi-stage urethroplasty was 67.3 % with a median follow-up of 62 months. Only 73 (66.4%) completed all stages of the planned surgery. Urethral integrity throughout its entire length was restored in 67 (60.9%) cases, spontaneous urination in 106 (96.4%) cases.&#x0D; CONCLUSIONS: Multi-stage surgery for anterior urethral strictures is associated with relatively high risks of surgical complications at each stage of treatment. The probability of surgical revision of complications can reach 31.8%. Patients should be informed about the risks of developing surgical complications and the potential for more than two surgeries to achieve treatment goals when planning multi-stage urethroplasty.

Comparison of Safety and Efficacy of Unilateral Spinal Anaesthesia and Ultrasound-guided Sciatic Femoral Nerve Block in below Knee Surgery: A Randomised Clinical Study

Introduction: With modern advances, Ultrasonography (USG)- guided regional block techniques have improved nerve blockade with lesser drug usage and maximum safety for patient care. The widely appreciated outpatient surgical care has compelled us to apply the fastest and safest anaesthesia technique. For lower limb surgeries, USG-guided Sciatic Femoral Nerve Block (SFNB) is an emerging alternative to Spinal Anaesthesia (SA). Aim: To compare the safety and efficacy of both techniques in terms of haemodynamic stability, quality of block, and postoperative analgesia. Materials and Methods: A randomised double-blind study conducted at GCS Medical College, Hospital, and Research Centre, Ahmedabad, Gujarat, India, on 80 patients aged 18 to 70 years of either sex, with American Society of Anaesthesiology (ASA) Grade 1 to 3, undergoing below-knee surgeries was divided into two groups. Group A received USA with 1.5 mL hyperbaric inj. ropivacaine 0.75%, and Group B received USGguided SFB with inj. ropivacaine 0.5% 30 mL (15 mL for sciatic nerve and 15 mL for femoral nerve block). Preparation Time (PT), Surgical Anaesthesia Time (SAT), haemodynamic changes, quality of block, Longevity of Anaesthesia (LoA), time of first rescue analgesia, time of spontaneous urination, readiness to discharge, and patient satisfaction were recorded. The statistical analysis was carried out using Statistical Package for Social Sciences version 23.0 (SPSS Inc., Chicago II, USA). The p-value was derived by unpaired t-test and Chi-square test. Results: PT and SAT were higher in Group B (12.10±2.02 mins and 15.74±1.58 mins) than in Group A (6.15±1.12 mins and 8.23±1.45 mins). LoA time and time to first rescue analgesic were higher in Group B (284.10±54.44 mins and 265.71±33.69 mins) than in Group A (138.75±23.30 mins and 132.40±17.41 mins). Time to first spontaneous urination and readiness to discharge were shorter in Group B (136.42±18.40 mins and 158.39±10.78 mins) than in Group A (162.20±26.54 mins and 181.53±18.18 mins). Haemodynamic stability was excellent in both groups with no significant fluctuation. Motor blockade of Bromage 3 grade was achieved in 40 and 38 patients in Group A and B, respectively. The development of VAS score &gt;3 was faster in Group A than in Group B (35 versus 2) at the end of three hours. No adverse events were observed in any patient. Conclusion: USG-guided SFB offers a safe and efficient alternative to Unilateral SA (USA) with satisfactory blockage, stable haemodynamics, and better postoperative analgesia for below-knee surgeries.

Effect of navel acupuncture on bladder emptying function in patients with urinary retention after stroke

To observe the effect of navel acupuncture on bladder emptying function in patients with urinary retention after stroke based on the conventional treatment. A total of 106 patients with urinary retention after stroke were randomly divided into an observation group (53 cases, 3 cases dropped off) and a control group (53 cases, 3 cases dropped off). Patients in the control group were treated with drugs, catheterization and bladder function rehabilitation training. On the basis of the treatment in the control group, the observation group was treated with navel acupuncture, 30 min each time, once every other day, for 4 weeks. The bladder residual urine volume, spontaneous urination volume and catheterization times before and after treatment were compared between the two groups, and the clinical efficacy was evaluated. After treatment, in the two groups, the bladder residual urine volume and catheterization times were lower than those before treatment (P<0.01), and the spontaneous urination volume was higher than that before treatment (P<0.01); the bladder residual urine volume and catheterization times in the observation group were less than those in the control group (P<0.05, P<0.01), and the spontaneous urination volume was higher than that in the control group (P<0.01). The effective rate of the observation group was 90.0 % (45/50), which was higher than 72.0 % (36/50) in the control group (P<0.05). On the basis of conventional treatment, navel acupuncture can effectively improve the bladder emptying function of patients with urinary retention after stroke.

Clean-catching urine from pigs: A method for collecting quality specimens for urinalysis and microbiological culturing in a laboratory environment.

Urine is an important biological specimen for assessing various metabolic functions and drug clearance. In urinary tract infection research, urine is particularly important as urinary bacterial titres constitute the main diagnostic outcome for assessing the course of infection. Collecting uncontaminated urine samples from pigs can be done by bladder catheterization or suprapubic bladder aspiration, which are both laborious and invasive procedures that require the need for anaesthesia. To improve animal welfare and optimize urine sampling protocols, we developed a method of clean-catching midstream urine specimens from pigs during spontaneous micturition. The quality of urine specimens collected by clean-catch, bladder catheter and suprapubic bladder aspiration were compared using microbiological culturing. We show that urine specimens collected by clean-catch are only minimally contaminated by skin- and vaginal-commensals with no influence on urinary bacterial titres during ongoing infection. In conclusion, we describe a method in which spontaneous micturition can be prompted in pigs, facilitating fast and reliable collection of quality specimens suitable for microbiological culturing. The method supersedes the need for anaesthesia, which not only represents a considerable refinement in terms of animal welfare but also facilitates more frequent collection of specimens that can enhance the scientific outcome of experimental animal studies in pigs.

Mild thermal stimulation of the buttock skin increases urinary voiding efficiency in anesthetized rats.

In the present study, we examined the effects of mild thermal stimulation of the skin on voiding efficiency using urethane-anesthetized rats with reduced voiding efficiency. Spontaneous urination was induced by infusing saline. For each voiding, the voiding efficiency was calculated from the voided volume and the bladder capacity measured. A Peltier thermode was attached to the buttock skin to apply stimulation: cooling between to 25°C and 35°C, every 20s throughout the saline infusion. The voiding efficiency was 29±9% (mean±SD) before stimulation and increased significantly by 10-15% during stimulation. During thermal stimulation, the maximum vesical pressure during micturition was unchanged, but the urethral relaxation duration was significantly prolonged. Applying local anesthesia to the stimulated skin area abolished the changes in voiding efficiency in response to thermal stimulation. These results suggest that the excitation of cutaneous thermoreceptive afferents modulates urethral function during urination, thereby improving voiding efficiency.

Initiating daily acute intermittent hypoxia (dAIH) therapy at 1-week after contusion spinal cord injury (SCI) improves lower urinary tract function in rat

Spinal cord injury (SCI) above the level of the lumbosacral spinal cord produces lower urinary tract (LUT) dysfunction, resulting in impairment of urine storage and elimination (voiding). While spontaneous functional recovery occurs due to remodeling of spinal reflex micturition pathways, it is incomplete, indicating that additional strategies to further augment neural plasticity following SCI are essential. To this end, acute intermittent hypoxia (AIH) exposure has been proposed as a therapeutic strategy for improving recovery of respiratory and other somatic motor function following SCI; however, the impact of AIH as a therapeutic intervention to improve LUT dysfunction remains to be determined. Therefore, we examined the effects of daily AIH (dAIH) on both spontaneous micturition patterns and reflex micturition event (rME) behaviors in adult female Sprague-Dawley rats with mid-thoracic moderate contusion SCI. For these experiments, dAIH gas exposures (five alternating 3 min 12% O2 and 21% O2 episodes) were delivered for 7 consecutive days beginning at 1-week after SCI, with awake micturition patterns being evaluated weekly for 2–3 sessions before and for 4 weeks after SCI and rME behaviors elicited by continuous infusion of saline into the bladder being evaluated under urethane anesthesia at 4-weeks after SCI; daily normoxia (dNx; 21% O2 episodes) served as a control. At 1-week post-SCI, both an areflexic phenotype (i.e., no effective voiding events) and a functional voiding phenotype (i.e., infrequent voiding events with large volumes) were observed in spontaneous micturition patterns (as expected), and subsequent dAIH, but not dNx, treatment led to recovery of spontaneous void frequency pattern to pre-SCI levels; both dAIH- and dNx-treated rats exhibited slightly increased void volumes. At 4-weeks post-SCI, rME behaviors showed increased effectiveness in voiding in dAIH-treated (compared to dNx-treated) rats that included an increase in both bladder contraction pressure (delta BP; P = 0.014) and dynamic voiding efficiency (P = 0.018). Based on the voiding and non-voiding bladder contraction behaviors (VC and NVC, respectively) observed in the BP records, bladder dysfunction severity was classified into mild, moderate, and severe phenotypes, and while rats in both treatment groups included each severity phenotype, the primary phenotype observed in dAIH-treated rats was mild and that in dNx-treated rats was moderate (P = 0.044). Taken together, these findings suggest that 7-day dAIH treatment produces beneficial improvements in LUT function that include recovery of micturition pattern, more efficient voiding, and decreased NVCs, and extend support to the use of dAIH therapy to treat SCI-induced LUT dysfunction.

Urinary retention after non-urological surgeries: Management patterns and predictors of prognosis

Objective:Urinary retention after non-urological surgery is a common morbidity, yet its​ etiology and treatment approaches are still a matter of debate. The primary aims of this study are to evaluate the management of urinary retention after non-urological surgeries, determine the predictors of prognosis, and report follow-up data. Methods:Patients who were referred to the urology clinic at a single center due to postoperative urinary retention between December 2014 and November 2021 were included. Demographical, clinical, and surgical parameters were recorded. In all patients, a urethral catheter was kept in-situ for at least 5 days after urinary retention. In case of persistent urinary retention after catheter removal, clean intermittent catheterization (CIC) was recommended. Results of the patients who spontaneously regained micturition after conservative treatment and those with persistent urinary retention were compared. Results:Among 95 patients, the median age was 65 (24–90) years. In 75 patients (78.9%), spontaneous micturition returned with conservative management (Group 1). Twenty patients (21.1%) required CIC due to persistent urinary retention (Group 2). The percentages of males in Group 1 and 2 were 81.3% and 50% respectively (p<0.05). The ratio of non-supine positioning in Group 1 and Group 2 were, 10.6% (8/75) and 35% (7/20), respectively (p=0.02). Female gender and non-supine operative position remained significant predictors of persistent urinary retention after conservative treatment with odds ratios of 3.5 and 3.6, respectively (Confidence intervals, 1.2–10 and 1–12.1, p= 0.02 and 0.04, respectively). During a median follow-up duration of 36 (2–86) months, only 5 patients (20%) stopped doing CIC and voided spontaneously. The median CIC duration of these 5 patients was 6 (1–9) months. Conclusion:The majority of the patients who developed urinary retention after non-urological surgeries regained spontaneous micturition with conservative management. Female gender and non-supine operative positioning were independent risk factors for persistent urinary retention. In patients with persistent urinary retention, spontaneous micturition could be expected to return in approximately 6 months.

Optimization of the Duration and Dose of Photobiomodulation Therapy (660 nm Laser) for Spinal Cord Injury in Rats.

Objective: Spinal cord injury (SCI) causes motor deficits, urinary incontinence, and neuropathic pain. This study was designed to optimize a photobiomodulation therapy (PBMT) protocol using a continuous wave (CW) 660 nm laser in rats with SCI. Specifically, the number of days of irradiation and the daily dose of PBMT were investigated. Methods: The study was performed in two steps. In the first step, a comparison between the effects of PBMT (45 sec) daily for 2 and 4 weeks on pain and movement [Basso, Beattie, and Brenham (BBB) score] was made. In the second step, a comparison between different durations of irradiation (27, 45, 90, and 117 sec) was performed. PBMT used a 100 mW laser delivered to 9 points on and around the lesion site. Oxidative stress, fibroblast invasion, and time to achieve spontaneous urination were also assessed. Results: The improvement in movement and pain stopped with discontinuation of radiation at week 2 and fibroblast invasion resumed. No improvement was seen in movement and pain in the group receiving PBMT for 27 sec compared with the groups receiving higher doses of laser radiation. Animals receiving 117 sec of photobiomodulation showed a higher BBB score even in the first 3 days. Conclusions: The number of days is an important factor for improving mobility; however, the daily dose of radiation is more important for pain relief.

Weekly Acute Intermittent Hypoxia as a Strategy to Restore Spontaneous Micturition Patterns in Awake Rats with Moderate Contusion SCI: Therapeutic Efficacy and Time Course

Both daily and weekly exposures to neuroplasticity‐inducing acute intermittent hypoxia (AIH) have been proposed as non‐invasive therapeutic paradigms to improve respiratory and motor function following spinal cord injury (SCI). SCI can also lead to bladder dysfunction that results in inefficient voiding and urine retention that are associated with a high degree of morbidity and a poor quality of life. Our ongoing preclinical studies have been investigating the therapeutic potential of AIH as a strategy to promote restoration of lower urinary tract (LUT; bladder) function in SCI. We have found that in rats with moderate contusion SCI, exposure to a single episode of AIH results in an immediate short‐term reduction in non‐voiding bladder contractions and induction of more efficient voiding while exposure to daily AIH for 7 consecutive days leads to sustained beneficial improvements in both spontaneous voiding pattern and reflex bladder function that persist for at least 2 weeks following completion of therapy. Here, we investigated the impact of weekly AIH (wAIH) exposures composed of five alternating 3‐min episodes of 12% O2 and 21% O2 on micturition patterns in adult female SD rats with mid‐thoracic moderate contusion SCI; weekly normoxia (wNx; 21% O2) exposures in a separate group of SCI rats served as a control. Overnight (awake) micturition chamber (MC) measurements were used to evaluate voiding patterns weekly before and for 10 weeks after SCI, with wAIH and wNx exposures being administered 3x per week for 4 weeks beginning at 4 weeks after SCI. Data acquired between 9:00 PM and 6:00 AM were used to quantify voiding pattern features (i.e., number of voids (#); inter‐void interval (IVI)) and voiding volumes (total volume; volume per void), with weekly pre‐SCI MC measurements averaged and set to 100% for each rat. To evaluate the magnitudes of the deficits and progression of recovery of micturition pattern behaviors, weekly post‐SCI MC measurements were compared to their pre‐SCI level. For both groups of rats, the voiding pattern at 1‐week post‐SCI was characterized by infrequent voiding events with large volumes (~50% decrease in number of voids; ~100% increase in IVI; ~4 fold increase in volume per void), and by 4‐weeks post‐SCI, similar limited partial spontaneous recovery of voiding pattern was noted in both groups, albeit deficits were still present. Subsequent wAIH treatment led to further improvements in voiding pattern, such that following 2‐weeks of wAIH treatment, the number of voids and IVI were restored to pre‐SCI levels, but with a sustained elevation in volume per void. The restoration of voiding pattern and elevated volume per void persisted for the remaining MC measurements, including those obtained at 2‐weeks following completion of wAIH treatment. In contrast, no further recovery of any voiding pattern features was observed in wNx‐treated rats. These observations suggest that wAIH therapy improves SCI‐induced bladder dysfunction, leading to restoration of spontaneous micturition patterns in awake rats with SCI.

MP01-01 EXIME® URETHRAL STENT IMPLANTATION (EUSI) AS INITIAL TREATMENT FOR PATIENTS PRESENTING WITH ACUTE URINARY RETENTION (AUR) FOR THE FIRST TIME AS A RESULT OF BPH

You have accessJournal of UrologyCME1 May 2022MP01-01 EXIME® URETHRAL STENT IMPLANTATION (EUSI) AS INITIAL TREATMENT FOR PATIENTS PRESENTING WITH ACUTE URINARY RETENTION (AUR) FOR THE FIRST TIME AS A RESULT OF BPH Nordine Amara, Tarek Al Youssef, Jordan Massa, Elias Elkhouri, and Belur Patel Nordine AmaraNordine Amara More articles by this author , Tarek Al YoussefTarek Al Youssef More articles by this author , Jordan MassaJordan Massa More articles by this author , Elias ElkhouriElias Elkhouri More articles by this author , and Belur PatelBelur Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Acute urinary retention (AUR) is a painful and distressing condition which is associated with significant morbidity requiring hospitalization, catheterization and often surgery. AUR often develops from benign prostatic hyperplasia (BPH) and its incidence increases with age. Management will often necessitates the insertion of a urinary catheter. We studied the efficacy of Exime® urethral stent implantation (EUSI) as initial treatment for patients presenting with acute urinary retention (AUR) for the first time as a result of BPH. METHODS: From January 2019 to January 2022 61 BPH patients underwent EUSI. The patients were aged 52–91 years old (mean 67.3 years), with a prostate volume of 30–120 ml (mean 67 ml) and IPSS score of 24±5.7. The same technique for insertion of EUSI under local anesthesia was used for each patient. RESULTS: Of the 61 patients 55 (90%) achieved spontaneous urination immediately after procedure; 3 patients (4.9%) developed urinary infection symptoms; 3 patients (4.9%) experienced bladder clot retention. No urethral injury and no false route were noted. CONCLUSIONS: EUSI, with its advantages of simple operation, high safety, definite effectiveness, is a new effective option for the treatment of AUR due to BPH. As more minimally invasive, office-based technologies emerge, physician and patients will have the ability to choose a treatment that is more catered to patient expectations. Further studies are needed to better define its place in this setting. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nordine Amara More articles by this author Tarek Al Youssef More articles by this author Jordan Massa More articles by this author Elias Elkhouri More articles by this author Belur Patel More articles by this author Expand All Advertisement PDF DownloadLoading ...

Evaluation of potential thiamazole exposure of owners of orally treated hyperthyroid cats.

The objective of this study was to evaluate the presence of traces of thiamazole in the urine of owners of hyperthyroid cats treated with antithyroid drugs. Urine was collected from 24 owners of hyperthyroid cats, five human patients treated with thiamazole and five healthy humans without any contact with antithyroid drugs. All owners of hyperthyroid cats were asked to fill out a questionnaire. Urine of hyperthyroid cats was collected by spontaneous micturition. All urine samples were stored at -20°C until analysis by ultra-high-performance liquid chromatography coupled to high-resolution quadrupole Orbitrap mass spectrometry. These owners were assessed to have a lot of contact with their cat. Adherence to antithyroid medication handling guidelines was rather poor. High concentrations of thiamazole were detected in all feline samples (median concentration 2818 ng/ml; range 104-15,127) and in the urine of all human patients treated with thiamazole (median concentration 4153 ng/ml; range 1826-5009). No thiamazole was detected in the urine of owners of hyperthyroid cats (limit of detection 3.88 ng/ml; limit of quantification 11.75 ng/ml). The results regarding the potential exposure of owners of hyperthyroid cats to antithyroid drugs are reassuring. Nevertheless, prudence is still warranted when administering antithyroid drugs. Whether these results can be extrapolated to the use of transdermal application requires further investigation.

Effect of Comprehensive Nursing Intervention Under Internet-Based WeChat Platform Education on Postoperative Recovery of Puerperae Undergoing Cesarean Section.

Objective To explore the effect of comprehensive nursing intervention under internet-based WeChat platform education on postoperative recovery of puerperae undergoing cesarean section (C-section). Methods A total of 96 patients undergoing C-section in our hospital from June 2018 to October 2021 were selected for the retrospective analysis and grouped according to the nursing intervention modes as follows: patients who received a routine nursing intervention were included in the control group, and patients who received comprehensive nursing intervention under internet-based WeChat platform education were included in the study group, with 48 cases each. After the intervention, the postoperative recovery of puerperae undergoing C-section and obstetrics nursing quality were scientifically assessed. Results No statistical differences in general data between the two groups were observed (P > 0.05). Compared with the control group, patients in the study group had obviously earlier initial time of lactation (P < 0.05), significantly higher breast milk amount within 48 h after delivery (P < 0.05), significantly earlier spontaneous urination time, anal exhaust time and off-bed activity time (P < 0.05), obviously better mastery of health knowledge (P < 0.05), and, in terms of SCL-90, remarkably lower total score, average total positive score, and the number of positive items and scores in dimensions, such as somatization, obsessive-compulsive, depression, anxiety, interpersonal sensibility, anger-hostility, phobic-anxiety, and paranoid ideation (P < 0.05). At discharge, 3 months, and 6 months of follow-up, patients in the study group obtained significantly higher scores on quality of life than the control group (P < 0.05). Conclusion In the nursing of puerperae undergoing C-section, comprehensive nursing intervention measures based on the internet-based WeChat platform education can effectively improve the early lactation, mastery of health knowledge, and adverse emotions of puerpera and promote their postoperative recovery.

Preliminary experience in endoscopic section of posterior urethral valves using the Holmium: YAG laser

Refinements in endoscopic instrumentation, the widespread popularization of endourology and the minimal invasiveness of endoscopic approaches have led to evolving interest in expanding applications for their use and now include incision of posterior urethral valves (PUV). We aimed to report our paediatric experience of PUV incision with Holmium:YAG laser updating of the endoscopic technique, how we set parameters for the laser energy and provide some tips and tricks to increase the likelihood of completing treatment. A monocentric, prospective, continuous series of boys with PUV were treated endoscopically using a Holmium: YAG laser (1.2J, 20Hz, 800μs). Feasibility was evaluated using operative time in minutes, spontaneous normal micturition after bladder catheter removal, and the duration of bladder catheterization in days in the absence of satisfactory micturition. Peri-operative complications were recorded. A VCUG was performed at 6 weeks postoperatively to exclude residual valves. Since September 2018, 18 children with PUV were included. The median age at the time of endoscopic laser incision was 12 days (1 day-5 years). The median operative duration was 28min (17-35). The urinary catheter was systematically removed on the first postoperative day. There were no intraoperative or anaesthesia-related complications. More specifically, no urethral injuries and no bleeding were recorded. No incomplete VUP incision was found on follow-up VCUG, and no endoscopic revision was necessary thus far, with a median follow-up of 44 months (6 months-60 months). The use of the Holmium: YAG laser introduces new perspectives in the treatment of PUV. Its mechanism of action is considered a photothermic effect with a vapourization effect. The laser energy released by the Holmium: YAG source has a short tissue penetration distance and is strongly absorbed in an aqueous environment and therefore limits thermal tissue damage and favours early tissue re-epithelialization, reducing the risk of urethral stricture and decreasing postoperative oedema. The use of the laser in "incision" mode is the setting that most solicits the capacities of the laser (high energy, high frequency, and long pulse). The use of laser energy has the advantage of allowing tissue vapourization while ensuring maximal haemostasis and the possibility of introducing the laser fibre through the working channels of small, 6-Fr paediatric endoscopes. In our experience, endoscopic PUV incision using the Holmium: YAG laser appears to be a safe and efficient technique.

Prostate arterial chemoembolization for treatment of refractory hematuria and urinary retention in patients with localized advanced prostate cancer.

To evaluate the safety and efficacy transcatheter arterial chemoembolization (TACE) for the treatment of refractory gross hematuria (RGH) and urinary retention (UR) secondary to localized advanced prostate cancer (PCa). Thirty-two patients (mean age 72.5 years, range 60-89) with advanced PCa-related RGH that failed conventional therapy were included. Twenty-two of these patients had catheter-dependent due to PCa-related UR. TACE was performed with epirubicin (EPI)-eluting HepaSpheres (HS) plus intra-arterial (IA) infusion of docetaxel. Technical success, adverse events (AEs), overall survival (OS), control of RGH, removal of indwelling catheters, and local disease control, were evaluated. Technical success was achieved in 100% without major AEs. Mean follow up post-TACE was 27 months (range 8-56 months) with a mean OS of 30 months. GRH stopped within 5 days after TACE in all patients, 26 (86.7%) of these patients exhibited good bleeding control during a mean follow-up of 24 months; 17 (77.3%) of the 22 patients with UR had recovered spontaneous urination, 15 (88.2%) patients were catheter-free at their last follow-up with a mean of 24 months. BS was obtained in 73.3% (22/30) of patients at a mean follow-up of 29 months. At the last visit, 22 patients had a mean of 36 months follow-up and the mean percentage reduction in prostate volume was 55.5%, with a statistically different from baseline (P = 0.022). Negative biopsy results were obtained in 84.2% (16/19) of the patients at 12-47 months after TACE. Compared with baseline values, there was a significant improvements in IPSS, QoL, Qmax, and PVR (all P < 0.05). TACE using EPI-eluting HS plus IA infusion of docetaxel is a safe and effective treatment option for the advanced PCa patients with GRH and UR, and it could be considered as an alternative if there was no other therapeutic choice.

Comparison of two diagnostic methods through blood and urine sample analyses for the detection of ketosis in cattle.

Background and Aim:Several Ecuadorian farms use human test strips (cheaper than veterinary strips) to diagnose bovine ketosis; however, their reliability is unknown. This study aimed to determine the confidence level of human strips for the detection of ketosis in bovines by comparing two diagnostic methods for ketosis: one used in bovines (gold standard) to analyze blood samples and the other used in humans to analyze urine samples.Materials and Methods:The study was conducted on an Ecuadorian farm using 50 animals, ten from each of five categories: heifers, 4 months pregnant (4MP), 15 days prepartum (15DPRE), 15 days postpartum (15DPOST), and 42 days postpartum (42DPOST). Blood samples were collected through coccygeal venipuncture and urine samples were collected during spontaneous urination. BHBCheck™ assay was used to measure b-hydroxybutyrate (BHB) in the blood, whereas Combur10Test® was used to measure acetoacetate (AcAc) in urine for the determination of ketosis.Results:BHB was detected in all animals. Based on a ketosis cutoff point of 0.8-1.2 mmol/L, 13 animals from the 15DPOST and 42DPOST categories had ketosis; AcAc was detected in the urine from nine animals originated from the two same categories. Metabolites, either BHB or AcAc, were not detected in heifers, 4MP, or 15DPRE individuals. Finally, the BHBCheck™ assay had better efficiency in detecting ketosis in animals (p<0.05) than the Combur10Test®.Conclusion:Combur10Test® urine strips reached 92% reliability for the detection of ketosis in dairy cattle, compared to BHBCheck™ assays.

Comparison of water vapor thermal therapy and prostate artery embolization for fragile patients with indwelling urinary catheters: Preliminary results from a multi-institutional study.

To report our preliminary experience with water vapor thermal therapy with the Rezūm™ System and Prostate Artery Embolization (PAE) for treatment of medically refractory, complete urinary retention to achieve successful cessation of catheter dependency in frail-patients. A multi-institutional study was conducted including all patients who underwent Rezūm™ procedure and PAE between October 2017 and June 2020. The included population focused on frail-patients unsuitable for conventional surgery with complete urinary retention. Rezūm™ patients were identified and matched (1:1) with patients who underwent PAE. The matching criteria were age, Charlson score, prostate volume and duration of follow-up. The primary outcome was catheter-free survival, defined as spontaneous voiding and release from catheter dependence. Eleven patients from the Rezūm™ group were matched to 11 embolized patients. PAE and Rezūm™ patients were comparable in age (median: 77 vs. 75 years), Charlson score (median: 6 vs. 6) and prostate volume (74 vs. 60 cc). Procedures were significantly longer in the PAE group compared to the Rezūm™ procedures (median: 148 vs. 8min, P<0.001). After a median follow-up of 12 months, spontaneous voiding was conserved in all cases (100%) after the Rezūm™ procedure and in 5 cases (45.4%) after PAE (P=0.01). In catheter-free patients, the rate of benign prostatic hyperplasia medication use after procedure was 40% for PAE and 18.2% for Rezūm™ patients (P=0.54). Our preliminary experience for treatment of complete urinary retention in frail-patients shows the feasibility of PAE and Rezūm™ to restore spontaneous urination without being associated with the occurrence of major complications. Early data suggests that Rezūm™ may provide superior results in terms of cessation of catheter dependence. Future studies are needed to definitively assess which treatment would be best suited for each patient. 3.