Urological Treatment Research Articles

Re: The Clinical Role of LASER for Vulvar and Vaginal Treatments in Gynecology and Female Urology: An ICS/ISSVD Best Practice Consensus Document.

Re: The Clinical Role of LASER for Vulvar and Vaginal Treatments in Gynecology and Female Urology: An ICS/ISSVD Best Practice Consensus Document.

Clustering of Patients with Interstitial Cystitis/Bladder Pain Syndrome and Chronic Prostatitis/Chronic Pelvic Pain Syndrome.

We performed clustering analysis of patient symptoms to discover common patient subtypes in females and males with interstitial cystitis/bladder pain syndrome or chronic prostatitis/chronic pelvic pain syndrome. The clinical variables included in k-means clustering were urological pain severity, urinary urgency, frequency and nonurological pain, each on a 0 to 10 numerical rating scale, and a yes or no response to each of the 6 UPOINT (Urological Treatment Program for Chronic Prostatitis) domains, including the urinary, psychosocial, organ specific, infection, neurological/systemic and skeletal muscle tenderness domains. Included in study were 211 patients seeking care of interstitial cystitis/bladder pain syndrome or chronic prostatitis/chronic pelvic pain syndrome. The k-means clustering algorithm identified 3 clusters of patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, including 1) a mild pelvic symptom cluster in about 30% of patients, 2) a severe pelvic symptom cluster in about 40% and 3) a systemic symptom cluster in about 30%. Patients in the systemic cluster were younger by about 5 to 7 years and more likely to be female. They had the most severe urinary symptoms (urgency, frequency and painful bladder filling), and the most severe pelvic and nonpelvic pain. They were also more likely to have chronic overlapping pain conditions, psychosocial issues (depression, anxiety and somatic symptoms) and poorer quality of life than patients in the 2 other pelvic clusters. They were not less likely to have Hunner lesions in the bladder. Symptom based clustering identified 3 clusters of patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. These patient subtypes had different pelvic and systemic presentations. Patients in the systemic cluster may benefit from interdisciplinary therapies. Future studies are needed to elucidate differences in pathophysiology among these clusters.

Comments on Preti et al: “The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document”

Comments on Preti et al: “The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document”

Electrical stimulation for neuroregeneration in urology: a new therapeutic paradigm.

The present review highlights regenerative electrical stimulation (RES) as potential future treatment options for patients with nerve injuries leading to urological dysfunction, such as urinary incontinence, voiding dysfunction or erectile dysfunction. Additionally, it will highlight the mechanism of nerve injury and regeneration as well as similarities and differences between RES and current electrical stimulation treatments in urology, functional electrical stimulation (FES) and neuromodulation. It has been demonstrated that RES upregulates brain-derived neurotrophic factor (BDNF) and its receptor to facilitate neuroregeneration, facilitating accurate reinnervation of muscles by motoneurons. Further, RES upregulates growth factors in glial cells. Within the past 2 years, RES of the pudendal nerve upregulated BDNF in Onuf's nucleus, the cell bodies of motoneurons that course through the pudendal nerve and accelerated functional recovery in an animal model of stress urinary incontinence. Additionally, electrical stimulation of the vaginal tissue in an animal model of stress urinary incontinence accelerated functional recovery. RES has great potential but future research is needed to expand the potential beneficial effects of RES in the field of urology.

Safety of Intrathecal Administration of Autologous Mesenchymal Stem Cells (MSCs) in Patients with Minimally Conscious State

Background: Patients who are in a minimally consciousness state (MCS) have often remained in the MCS for a long time. At the moment, the only chance for these patients seems to be the development of regenerative medicine based on stem cells as the studies on laboratory animals have demonstrated promising results. The favourable outcomes of these experiments insentivize to check the safety of using similar tests in humans. The aim of this study was to evaluate the safety of intrathecal administration of autologous bone marrow derived-mesenchymal stem cells (BM-MSCs) in patients with minimally conscious state. Methods: The study involved 28 patients diagnosed with persistent consciousness disorder who had completed an intensive care unit therapy at University Clinical Hospital in Olsztyn, Poland. The patients were referred for an in-patient care and admitted to hospital in a regular mode without prior verification of the diagnosis. All patients were evaluated according to a uniform test protocol. Diagnostics included a neurological, internal, cardiological and ENT examinations as well as anesthesiological, and rehabilitation assessment, and logopedic and psychological tests. The next stage of the experiment covered 9 selected MCS patients. This stage aimed at establishing a colony of autologous stem cells derived from the bone marrow and then three intrathecal administrations of stem cells at 2 month intervals. All the patients underwent a thorough virological examination before the stem cell cultures were started. The BM-MSC transplantation procedure safety assessment relied on a thorough analysis of the immediate and delayed adverse events. The immediate adverse events comprised an allergic reaction, respiratory failure, local complications (hematoma, local infection), and paralysis. Among the delayed adverse events an intraspinal tumor formation, permanent loss of sensation and paralysis, unrelated to the progress of the disease, were determined. During the hospitalization, a daily assessment procedure of the patient's condition was adhered to and the data recorded in the patient's medical chart. Findings: No severe side effects were documented during the procedure. of the patients demonstrated any symptoms of infection. In 2 patients, an increased psychomotor activity was observed, more increased when placed on the side from which the bone marrow had been collected. In one patient it was necessary to repeat the bone marrow collection due to the detection of bacteria in the stem cell culture. Out of the 9 patients, 3 were administered 3 intrathecal doses. In 2 patients, there were 2 intrathecal stem cell administrations completed, and in 1 patient, after the first administration, the subsequent doses were abandoned. Moreover, in a group of 6 patients, who had undergone 3 administrations, 1 patient had to have the treatment postponed due to an upper respiratory tract infection. In 1 patient, after two intrathecal administrations of stem cells without any evidence of adverse effects, the third dose could not have been given on account of a necessary urological treatment in another medical center. Thus, this patient had to be excluded from the experiment. In 1 patient, an epileptic status occurred after the first injection of stem cells. Due to the unclear coincidence of the epileptic status with the administration of stem cells, any subsequent administrations were abandoned. Interpretation: The study showed more difficulties occurring in patients with consciousness disorders than in patients treated for other diseases. Moreover, data collected based on a small and changeable group of patient require to be confirmed in a study encompassing a larger group of patients. However, in the course of any further research, the risks of this treatment should be borne in mind and proper precautions employed. Funding Statement: This work was supported by the National Centre for Research and Development (No: STRATEGMED I/234261/2/2014). Declaration of Interests: The authors state: None to declare. Ethics Approval Statement: The study was approved by the Bioethical Committee of the Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Poland (ethical approval No. 7/2013 of February 2013, and No. 46/2013 of December 2013). The study was carried out in accordance with the provisions of the Declaration of Helsinki.

Contemporary Landscape and Strategies to Engage Women Urologists in Treatment of Male Sexual Function

Contemporary Landscape and Strategies to Engage Women Urologists in Treatment of Male Sexual Function

Workload, job satisfaction, Work Time Act-what is urology doing?

Due to demographic changes, the proportion of people requiring urological treatment will continue to rise. In order to better address this development, we need a well-trained and motivated urological medical community. Not only is continued education in urology an integral part of this, but it must also be embedded into future-oriented, flexible work-hour models, taking into account the German Work Time Act. Thus, in order to obtain a better assessment of the current situation of urological physicians undergoing specialist training, work -hour models currently used in urological clinics must be evaluated. This should allow conclusions to be drawn to find future-oriented solutions in order to do justice to the Future Offensive-Urology in 2025. Transparency, openness, and cooperation should be top priority between the DGU (German Association for Urology) working groups active in this field and the working groups of the BvDU (German Professional Association for Urologists).

Degloving Penile Injury with Urethral Avulsion: A Case Report

Accidental male genital injuries represent a serious urological disorder that demands immediate urological treatment due to risk of infection and need for fertility preservation. We reported a 30- year-old gentleman who presented with an extensive penile degloving injury, right open pneumothorax and right thigh laceration following a buffalo attack. Examination under anesthesia (EUA) demonstrated ruptured penis with tearing up to penile base and partially avulsed right testis. Right orchidectomy, wound debridement and suprapubic catheter insertion performed before being referred to Penang General Hospital. Repeated EUA revealed avulsed penile urethra 3cm from the meatus with interposing granulation tissue of 2cm in length. He underwent serial wound debridement and eventually required a split skin graft to the penis. Patient was reported to be able to achieve penile erection by 2 months post-operative and planned for urethroplasty later. This is the first paper that reports an incident of buffalo attack resulting in degloving injury of penis. Management depends on severity of trauma and prompt intervention essential to prevent immediate as well as delayed complication. Urethral injury must be considered in any extensive penile injury. Despite multiple modality for traumatic penile skin loss repair, split thickness skin grafting (SSG) was chosen for this patient. Conclusion: External injuries of the genitals, particularly caused by animal attack, should be followed by immediate operative exploration and if necessary, to reparative measures. Care must be taken with goal of optimizing long term sexual, cosmetic and voiding outcomes.

The Clinical Role of LASER for Vulvar and Vaginal Treatments in Gynecology and Female Urology: An ICS/ISSVD Best Practice Consensus Document.

In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. Most of the available studies are limited by their design; for example, they lack a control group, patients are not randomized, follow-up is short term, series are small, LASER is not compared with standard treatments, and most studies are industry sponsored. Because of these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration after LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, although short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. Therefore, at this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well-designed clinical trials or with special arrangements for clinical governance, consent, and audit.

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document.

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology is controversial. In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. This project was developed between January and September 2018. The development of this document followed the ICS White Paper Standard Operating Procedures. Most of the available studies are limited by their design; for example they lack a control group, patients are not randomized, follow up is short term, series are small, LASER is not compared with standard treatments, and studies are industry sponsored. Due to these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration following LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, while short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. At this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well-designed clinical trials or with special arrangements for clinical governance, consent, and audit.

An Interesting Case Report of a Giant Bladder Calculi in China

Objective: To report a giant bladder calculi in a 52-year-old man. Methods: The patient was diagnosed as bladder calculi since 1998. Due to the lack of sufficient medical and health conditions in the countryside, he only received the Chinese traditional treatment and did not seek any urologic treatments for more than 20 years. In April 2018, he was referred to our hospital with dysuria. Results: A big bladder calculi (8.0 cm × 10.0 cm × 6.0 cm in size) was revealed by ultrasound and intravenous pyelography and removed by open cystolithotomy. Conclusions: Our case demonstrates the necessity of early treatment for patients with bladder calculi.

Prospective evaluation of the management of bowel dysfunction in children with neuropathic lower urinary tract dysfunction and its effect on bladder dynamics

Introduction and AimChildren with neuropathic lower urinary tract dysfunction usually suffer from associated bowel dysfunction, urinary tract infection and vesicoureteral reflux. This work aimed to highlight the impact of bowel management on bladder dynamics. Patients and methodsIn the period from January 2011 to January 2013, 30 patients, 21 girls and 9 boys with neuropathic lower urinary tract dysfunction were studied. All suffered from urinary tract and bowel dysfunctions. All children were on urological treatment. They had their bowel managed by assurance and psychological support, dietary modification, retrograde or antegrade enemas and maintenance therapy. They were evaluated initially and on follow up by history, physical examination, ultrasound, urodynamics, Wexener score and bowel control chart. ResultsMean age was 8.3 ± 3.47 years (range from 4 to 18). There was a significant decrease in bowel dysfunction (Wexener score decreased from 12.67 ± 1.54 to 10.17 ± 1.76, p = 0.00), rectal diameter (decreased from 34.83 ± 5.91 to 27.90 ± 5.32 mm, p = 0.00), and frequency of UTI (p = 0.00). Detrusor leak point pressure decreased from 37.33 ± 24.95 to 30 ± 17.35 cmH2O, (p = 0.42). The cystometric capacity increased from 136.63 ± 45.69 to 155.17 ± 39.29 ml. (p = 0.001). Reflux and kidney function improved but was not statistically significant (p = 0.25 and p = 0.066 respectively). ConclusionManagement of bowel dysfunction is of utmost importance in the treatment of children with neuropathic bladder dysfunction. It has a positive effect on lower urinary tract function and decreasing the incidence of complications.This is a LEVEL III prospective study.

Recommendations for Antibacterial Prophylaxis in Endourological Procedures

This review discusses the evidence and newly identified findings of antibiotic prophylaxis in endourological procedures based on recently published studies. Endoscopic procedures and surgeries are performed widely to treat a variety of urologic diseases. The panel of European Association of Urology (EAU) guidelines on UTIs decided not to make recommendations for specific agents for particular procedures because there are considerable variations in Europe and worldwide regarding bacterial pathogens, their susceptibility, and the availability of antibiotic agents in 2018. In the EAU guidelines, antimicrobial prophylactic therapies cannot decrease the rate of symptomatic UTI in several procedures, including cystoscopy and extracorporeal shock wave lithotripsy. Perioperative antibiotic prophylaxis can be helpful in all patients undergoing endourological treatment, including ureteroscopic surgery and percutaneous nephrolithotomy. Because the urological practice is a part of the surgery, most urological treatment can be performed mainly by surgery. The prevention of surgical infections in each surgical field is a critical issue, but the evidence and number of guidelines are limited.

Prise en charge du rétrécissement urétral acquis: expérience du Service de Chirugie Générale de Sikasso

Le rétrécissement urétral est une pathologie dont l'étiologie et la prise en charge varient selon le contexte. L'objectif de l'étude était de procéder à une analyse des aspects épidémiologiques, étiologique et thérapeutique du rétrécissement urétral dans notre contexte. Il s'agit d'une étude transversale longitudinale portant sur les cas de rétrécissement urétral acquis admis dans notre service entre mars 2014-février 2016. Age moyen: 24,5ans (10 et 81 ans). Le diagnostic fut confirmé par l'Uretro-Cystographie Rétrograde et Mictionnelle (UCRM). La longueur moyenne du rétrécissement était de 2,28cm (0,5-5cm). Les modalités thérapeutiques adoptées: la Résection Anastomose Termino-Terminale (RAT-T); la Dilatation Urétrale Rétrograde Itérative (DURI) etc. L'évaluation du résultat 6-15 mois postopératoire; satisfaisant en l'absence de récidive, RPM ≤30cc et un jet urinaire fort et mauvais en cas de récidive de dysurie ou RPM ≥100cc. Le RU occupe 7,14% de nos activités urologiques. La plus part de nos patients sont des cultivateurs provenant de la zone rurale. Les antécédents d'urétrite répétée ont été le plus souvent évoqués par nos patients et 78,57% d'entre eux étaient des hommes mariés dont 91% polygames. Les patients ont consulté surtout pour dysurie soit 50% de l'effectif et 50,01% de nos patients ce sont présentés avec une infection urinaire secondaire dont le germe prédominant est Escherichia coli. L'étiologie infectieuse a été la plus dominante soit 56,52%. La portion la plus atteinte a été l'urètre bulbaire soit 45,60% des cas. La RAT-T a été la technique la plus utilisée soit 39,13%. Globalement nous avons eu 85,65% de bon résultat et 13,04% d'échec; les taux de succès les plus élevés ont été obtenus avec la résection anastomotique soit 94,44% respectivement. Le rétrécissement urétral reste une pathologie fréquente chez les jeunes. L'étiologie infectieuse demeure la plus dominante dans notre contexte. L'accent doit être mis sur la prévention et la Prise en Charge (PEC) efficace et efficiente des Infections Sexuellement Transmissible (IST).

Lower urinary tract symptoms and feeling of incomplete emptying in Saudi Arabian men and its correlation with postvoid residual urine.

Purpose:This study was conducted to assess the clinical value of postvoid residual (PVR) urine measurement and associate it with the feeling of incomplete emptying in men with lower urinary tract symptoms.Methods:Two hundred men were surveyed in the King Fahd Hospital of the University. Patients who had previous urological surgery and patients who are currently on urology treatment were excluded. Information from the remaining 181 patients was analyzed. International Prostate Symptom Score (IPSS) sheets were filed, and then, the PVR was measured.Results:Data from IPSS sheets were evaluated: 45 patients (24.8%) were characterized as experiencing no symptoms (Score: 0 and 1), 87 (48%) as mild-to-moderate symptoms (Score: 2 and 3), and 49 (27%) as severe symptoms (Score: 4 and 5). The PVR measurement showed no statistical difference in all three categories (being 10, 13, and 12, respectively). Feeling of incomplete emptying despite little PVR was frequently observed.Conclusion:The study concluded that the feeling of incomplete emptying was poorly correlated with PVR urine volume measurement. This feeling was significantly associated with worsening of both voiding and storage symptoms.

Острый неосложненный цистит: следуем ли мы рекомендациям?

Lower urinary tract infection are a common urologic disease, but a therapy is not always optimal. to evaluate the compliance of prescriptions made by urologists in treatment of patients with lower urinary tract infection, in particular with acute uncomplicated cystitis. A specially designed questionnaire was filled out by 161 urologists from Novosibirsk, Barnaul and Krasnoyarsk, as well as participants of VII Congress of urologists of Siberia. The survey showed that 34.8%, 27.9%, 22.4% and 14.9% of urologists had 6-10, 11-20, 1-5 and more than 20 patients with acute uncomplicated cystitis a month, respectively. According to results, 91.9% of urologists are familiar to National guidelines on treatment of lower urinary tract infections and 91.2% of doctors consider them to be reasonable. Among those surveyed, 29.2% of urologists believe that National Guidelines differ from European Guidelines; 95.7% of participants adhere to recommendations, but only 47.4% respect it almost always, 16.9% do it in half of cases and the remaining 35.7% comply with them in less than 40% cases. Moreover, 86.4% of urologists started a treatment of acute cystitis with antimicrobial therapy and preferred fosfomycin in 41.0%, nitrofurans in 20.9%, fluoroquinolones in 21.6% and cephalosporins in 16.5% cases, respectively. Almost all respondents (93.8%) are convinced that antibiotic therapy should be accompanied by phytotherapy, and 71.5% of urologists administer Canephron. In the urologic community there are controversies in the treatment of patients with acute uncomplicated cystitis. The choice of therapy is not always optimal.

Rationales for a Urodynamic Study in Patients with Cervical Spondylotic Myelopathy

Detrusor sphincter dyssynergia, involuntary detrusor contractions (IDCs), and poor bladder compliance are common urodynamic findings in cervical spondylotic myelopathy (CSM). There is little information regarding the role of a urodynamic study after decompression surgery for CSM. Urodynamic study was performed before and 6 months after decompression of CSM. Japanese Orthopaedic Association score for cervical myelopathy and Neck Disability Index functional score were applied. International Prostate Symptom Score was applied in male patients, and 6-item Urogenital Distress Inventory was applied in female patients. Mean patient age was 61.3 years. Final follow-up was obtained in 17 of 32 patients. Neurogenic bladder was confirmed in 11 (64.7%) patients, with 7 patients having poor bladder compliance, 3 patients having IDCs, and 6 patients having detrusor sphincter dyssynergia. Poor bladder compliance was normalized in 4 of 7 patients. IDCs disappeared in 2 (phasic IDCs) of 3 patients and improved in 1 (terminal IDC) patient. Detrusor sphincter dyssynergia markedly improved in 4 of 6 patients. Bladder compliance in 17 patients was 45.52 ± 23.71 before decompression surgery and 77.07 ± 39.85 after decompression surgery (P= 0.004). Both Japanese Orthopaedic Association and Neck Disability Index scores improved (P= 0.007 and P= 0.001, respectively). International Prostate Symptom Score and 6-item Urogenital Distress Inventory were not changed 6 months after surgery. Neurogenic bladder could be partially controlled in patients with CSM after surgical decompression. The neurogenic component in the urodynamic study findings varied. Depending on the findings, further appropriate urologic treatments after neurologic decompression surgery should be considered.

Effects of Calcium Oxalate on Expression of Clusterin and Lower Urinary Tract Symptoms in Prostatitis and Benign Prostatic Hyperplasia Patients with Calculi.

BackgroundProstatic calculi are common in urological treatments. Our major purpose in the present study was to explore the occurrence and composition of prostatic calculi, and investigate the effect of calcium oxalate (CaOx) on clusterin expression and lower urinary tract symptom (LUTS) in prostatitis and benign prostatic hyperplasia (BPH) patients with calculi.Material/MethodsFrom December 2016 to January 2017, a total of 79 prostatitis patients aged more than 50 years were enrolled. The patients were divided into 3 groups: group A had small calculi (discrete, small echoes); group B had large calculi (large masses of multiple echoes, much coarser), and group C had no calculi. Immunohistochemical analysis was performed to evaluate the tissue scores. The clusterin expression was detected by quantitative real-time CR (qRT-PCR), Western blot, and immunofluorescence.ResultsAccording to multifactor analysis, age was significantly associated with prostatic calculus. The composition of prostatic calculus was an independent factor of LUTS. The clusterin expression was elevated in group B. The mRNA and protein levels of clusterin in prostatitis and BPH patients with stones were obviously higher than those in prostatitis and BPH patients without stones. CaOx enhanced clusterin expression in a dose-dependent manner.ConclusionsLarge prostatic calculi were associated with LUST. Furthermore, CaOx enhanced clusterin expression, leading to large prostatic calculi. These results may provide a therapeutic strategy for prostatitis and BPH.

Scientific-practical Conference «Modern Methods of Diagnostics and Treatment in Urology, Andrology and Oncology»

У місті Дніпро з 4 по 5 жовтня 2018 року було проведено науково-практичну конференцію за участю міжнародних спеціалістів «Сучасні методи діагностики та лікування в урології, андрології та онкоурології», яку було присвячено 220-річчю від дня заснування Дніпропетровської обласної клінічної лікарні ім. І.І. Мечникова. Організаторами конференції були: Міністерство охорони здоров’я України, Асоціація урологів України, Асоціація урологів Дніпропетровської області, ДЗ «Дніпропетровська медична академія МОЗ України», Департамент охорони здоров’я Дніпропетровської обласної державної адміністрації.

Uterine Cervical Cancer and Chronic Kidney Disease An association that should not be skipped

We present the case of a 65 year old female patient with a history of bilateral hydronephrosis (known for about 3 years) diagnosed with keratinizing squamous carcinoma and chronic kidney disease. The low adherence of the patient to the uterine cervical cancer screening program led to the diagnosis of tumor in an advanced stage. In this patient, specific urological treatment (bilateral percutaneous nephrostomy) was not associated with significant improvement in renal function, and therefore she was deemed ESRD, dialysis dependent.