Urinary Complaints Research Articles

Preliminary Phytochemical Analysis on The Leaves Extracts of Sida acuta Burm.f. and Sida rhombifolia Linn. Family Malvaceae

To investigate the phytochemical screening (group determination) of the plants leaves of Sida acuta Burm.f., and Sida rhombifolia Linn. family Malvaceae. In Ayurvedic system of medicine Sida acuta Burm.f., used as digestive, diuretic, fever, burning of the body and urinary discharge. Sida rhombifolia Linn. used as good in urinary complaints, discharge and strangury, useful in fever, heart diseases, burning sensations, piles, all kinds of inflammations. Present study involved Leaves of Sida acuta Burm.f., and Sida rhombifolia Linn. were studied by preliminary phytochemical screening of leaf powders using different solvent viz; petroleum ether, chloroform, acetone, ethanol and aqueous. Leaf extracts were subjected to preliminary phytochemical analysis of using standard procedures. The phytoconstituents present in it viz. alkaloids, carbhohydrates, glycosides, phytosterols, phenolic compounds, tannins, flavonoids, lignins and saponins are present in leaf extracts of Sida acuta Burm.f., and Sida rhombifolia Linn. The active principles of Sida acuta Burm.f., and Sida rhombifolia Linn. namely Manghaslin, Quercetin 3-(2Gxylosylrutinoside), Myricetin 7-Rhamnoside, Isorhamnetin 3-O-[b-D-glucopyranosyl-(1->2)-a Lrhamnopyranoside], Quercetin 3-(2Gxylosylrutinoside), Peltatoside, Rutin, Quercimeritrin are present. The diversity of phytochemicals study can serve as a valuable source of information and provide suitable standards for identification of this plant material in future investigations.

Comparative Analysis Between Urinary Complaints and the Results of the Urodinamic Study of Women Seen at a Urogynecology Ambulatory in Macapa-Aresume

Introduction: Urinary Incontinence (UI) is investigated through clinical history, physical exam, urinalysis, voiding diary, Pad-test, urodynamic study and imaging exams. Objective: To assess the efectiveness of the urodynamic test in proving UI. Methodology: Retrospective-cross-sectional-observational descriptive quantitative study. We analyzed the medical records of 594 women treated at the Women Hospital and Maternity “Mãe Luzia” – WHML in Macapá – AP aged 18 years or older, with complaints of urinary incontinence and who underwent urodynamic examination without any Other associated conditions. Statistical analysis was performed using the Chi-squared test, Mann-Whitney U test or Kruskal-Wallis test. Values of p < 0.05 were considered statistically significant. The research received authorization from the Ethics and Research Committee of the Federal University of Amapá (FR 347446/011). Results: 49.49% presented clinical complaints. Of those, 13.9% were compatible with Overactive Bladder (OAB), 11.2% with Stress Urinary Incontinence (SUI) and 74.8% with Mixed Urinary Incontinence (MUI). 50.5% were diagnosed by urodynamics, being 0.7% normal, 15.7% OAB, 14% SUI and 69.7% MUI. 45.2% of SUI and 46.4% of MUI were concentrated in pressure loss of up to 60cmH2O. As for age, 27.7% of those with OAB were between 31-40 years old, while 38.8% with MUI 41-50 years and 28.6% with SUI 51-60. The percentagem of women who had a clinical complaint and a corresponding urodynamic finding was Only 1.7% for SUI, 52.3% for MUI and 5.7% for OAB among those evaluated. Thus, urodynmics for SUI had a sensitivity of 89.1%, specificity of 11.9%, PPV of 86.1%, NPV of 15.2%, and accuracy of 78.3%, for BH it had a senstivity of 90.5%, specificity of 36.2%, PPV of 88.4%, NPV of 41.5%, and accuracy of 82% and for IUM it has a sensitivity of 30.8% and a specificity of 75.1%, leading to a PPV of 35.0% and a NPV of 71.4%, and therefore with an accuracy of 61.7%. Conclusion: Correspondence between clinical complaint and urodynamic study was low. Further studies are still needed in this regard for a final conclusion on the effectiveness of the urodynamic test for the diagnosis of UI.

Is there a correlation between meatal stenosis severity, lower urinary tract symptoms and uroflowmetry?

We have recently validated a meatal Stenosis (MS) severity grading system that is based on physical examination. The study objective was to examine the correlation between this grading system, patients' urinary symptoms, uroflowmetry and postvoid residual parameters. Patients referred for our clinic for urinary and non-urinary complaints, were prospectively enrolled. Urinary symptoms questionnaire, uroflowmetry parameters and post-voiding residuals (PVR) were assessed, and photographs of the urethral meatus were taken for each patient. The photographs were graded blindly according to the previously validated grading system and correlated with urinary symptoms, uroflowmetry parameters and PVR. Overall, 75 patients were assessed (20 grade 0, 23 grade 1 and 32 grade 2). When using grade 0 as a reference, the odds ratio (OR) for reporting narrow stream was 6.4 (95%CI 1.65-24.77) and 4 (95%CI 1.18-14.16) for grade 1 and 2 respectively. OR for prolonged urination was 6 (95% CI 1.47-24.89) for Grade 1 and 2; OR for upward stream deviation was10.08 (95%CI -2.43-41.82) for grade 1 and 15.12 (95%CI-3.74-61.17) for grade 2. Uroflowmetry results showed lower Qmax from 16.8(SD±8.0) ml/sec in grade 0-9.6ml/s on grade 1 and 2 (p<0.001) (Figure1). PVR was not statistically different in the three groups. Our main findings were that meatal stenosis severity grade is associated with narrow stream as reported by parent, prolonged urination, and upward deviation of urinary stream, with increasing severity with worsening stenosis. MS grade was also associated with significant worsening of uroflow measures: a lower Qmax, Qmean and a longer time-to-Qmax. Post-void residual volume was not significantly different between the different severity grades. This study showed the clinical significance of the grading system. With subjective and objective measures. The implementation of this grading system in clinics, may aid in decision making regarding surgical intervention in the appropriate patients, and avoid unnecessary procedures. The Severity of MS seen on physical examination correlates well with obstructive symptoms and decrease of urine stream seen on uroflowmetry. These findings confirm the importance of the grading system in the evaluation of patients with MS and may be additional measure that assist in consulting parents on the indications to meatotomy.

No pelvic exam, no problem: patient satisfaction following the integration of comprehensive urogynecology telemedicine.

Introduction and hypothesisThe COVID-19 pandemic revolutionized the practice of medicine, requiring rapid adoption of telemedicine. However, patient satisfaction has not been well characterized for telemedicine visits for a broad range of urogynecologic conditions.MethodsWe performed a cross-sectional survey study following a retrospective review of all urogynecologic telemedicine visits from March 1, 2020, to March 31, 2021, at a tertiary care center. The survey queried patient satisfaction using the Likert scale. Descriptive statistics and Fisher’s exact analyses were performed.ResultsThere were 256 telemedicine visits at our institution during the study period, and 88 patients (34% unadjusted response rate) completed the survey. The average age of study participants was 55 (SD 17; 24, 84) years old. The majority of patients were white (69%), lived within the five boroughs of NYC (81%), and had higher levels of education (72% with a bachelor’s or professional degree). Most visits were for urinary complaints (68%), with those patients reporting greater fulfillment of urogynecologic needs compared to patients presenting with pelvic complaints (p = 0.02). There were no significant differences in satisfaction among other demographics (p > 0.05). Altogether, high satisfaction rates were noted for scheduling (99%), technology (90%), provider interaction (96%), fulfillment of personal needs (91%), and overall satisfaction (94%).ConclusionsWe demonstrate high patient satisfaction for telemedicine visits in a tertiary urogynecology clinic for a variety of indications, with greater fulfillment of urogynecologic needs observed for those visits which may not necessitate an in-person exam (e.g., urinary complaint).

COMPARISON OF URINE DIPSTICK WITH URINE CULTURE IN DIAGNOSIS OF URINARY TRACT INFECTION IN CHILDREN.

BACKGROUND: Urinary tract infection (UTI) is a common cause of morbidity in the paediatric age group. In general practice, 6-8% of febrile infants who are unwell and older children having urinary complaints will have UTI. It may lead to long- term complications like loss of normal function, renal scarring and hypertension. Thus, prompt detection and treatment of UTI is important. AIMS AND OBJECTIVES: 1. To evaluate the accuracy of dipstick leukocyte esterase and nitrite tests for rapid screening of urine samples, keeping semi quantitative Urine culture as the gold standard for the diagnosis of UTI. 2. To study the clinical prole of UTI in children. METHOD: A hospital based, prospective, cross sectional study was conducted with a total of 100 febrile children between the age of 1year to less than 18 years who came to department of Paediatrics, MMIMSR, both inpatient and out-patient department were included in the study. Two urine samples were collected out of which one was sent for urine culture and the other was used for urine dipstick test and urinalysis. RESULTS: Out of 100 febrile children suspected to have UTI, Urine culture was found to be positive in 49% cases. E.coli was found to be the most common organisms causing UTI. Out of 49% culture positive cases, 55% were females. The most common age group to have culture positivity was found to be 12 years to less than 18 years of age. The most common features associated with culture positive UTI were found to be vomiting and pain abdomen along with fever. The leukocyte esterase test and nitrite test have a sensitivity and specicity of 81.63%, 88.24% and 32.65%, 96.08% respectively. Thus, leukocyte esterase can be used to screen UTI in paediatric age group. Microscopic urinalysis is comparable to leukocyte esterase with sensitivity of 73.47% and specicity of 92.16%. When leukocyte esterase and nitrite tests are used in combination, the sensitivity increases to 86% and specicity to 88%. When all three are used together the ability to diagnose UTI improves further. CONCLUSION: Urine dipstick test (leukocyte esterase and nitrite reduction test), is a rapid and feasible method to screen urinary tract infection in children.

Hepatic Abscess as the Etiology of Fever of Unknown Origin in a Pediatric Patient.

A 16-year-old boy with no reported past medical history presented to an urban, high-volume pediatric emergency department (ED) with a 2-week history of intermittent fevers and chills, posterior headaches, nausea along with nonbloody emesis, and two fleeting episodes of generalized abdominal pain. He did not have any diarrhea or urinary complaints, but did notice that his urine was more orange in color. The day prior to his ED presentation, he started feeling generally weak and lightheaded. The patient's mother had been giving him ibuprofen, with improvement of his fever.

Preparation and Standardisation of Mother Tincture from Strychnos potatorum: A New Drug Source in Homoeopathy

AbstractStrychnos potatorum L.f. is a deciduous tree of 12 metre height, belongs to Loganiaceae family under genus Strychnos and is commonly distributed throughout India. Its flowering time is from February to May and fruiting time from October to March. This plant contains diaboline as active compound and besides it, terpenoid, cardiac glycoside and phenolic compounds as other phytochemical constituents. Recent study has revealed that the plant's seed has antidiabetic, nephroprotective, hepatoprotective, antipyretic, antineoplastic, antimicrobial and contraceptive properties. Hence different systems of medicine like Ayurveda, Unani and Siddha have included this plant in their pharmacopoeial preparation and use it according to their own principles. Ayurvedic system uses the seed against skin disease, gonorrhoea, fever and inflammation of the eyes. Unani system uses it for treatment of urinary complaints whereas Siddha system uses it for treatment of chronic obstructive pulmonary disease. Genus Strychnos is a well-known genus to homoeopathy system. Drugs like Ignatia and Nux vomica belong to this genus, but no data till today regarding the above-stated plant are available in the homoeopathic pharmacopoeia of India. So, the objective of this physiochemical study is to search the scope of inclusion of this plant as new medicinal source in homoeopathic system of medicine for the purpose of drug proving. Keeping this objective in our mind, chemical analysis of the ethanolic extract of the seed was done by thin layer chromatography and ultraviolet-visible spectrophotometry, which was followed by preparation and standardisation of mother tincture.

A large intra-abdominal leiomyoma with unusual urinary symptom: case report

Abdominal or intra-abdominal masses are defined as any enlargement or swelling localized in the abdominal area. Intra-abdominal masses can be diagnosed from abdominal symptoms or through physical examination, as well as can incidentally be detected from radiological imaging performed for other reasons. In this study, the diagnosis and treatment of intra-abdominal mass in a 27-year-old nulliparous female patient with unusual urinary symptom is presented. Preoperative magnetic resonance (MRI) images showed an intra-abdominal solid mass. The mass excision was performed, and surgical recovery was achieved. Pathological results revealed that the mass was a large leiomyoma of 15 cm×14 cm×11 cm size with extrauterine localization, which is quite rare in the literature. Post-operative results showed that the patient’s existing urinary complaint had completely disappeared.

Phytochemistry and Diverse Pharmacology of Genus Mimosa: A Review.

The genus Mimosa belongs to the Fabaceae family and comprises almost 400 species of herbs, shrubs and ornamental trees. The genus Mimosa is found all over the tropics and subtropics of Asia, Africa, South America, North America and Australia. Traditionally, this genus has been popular for the treatment of jaundice, diarrhea, fever, toothache, wound healing, asthma, leprosy, vaginal and urinary complaints, skin diseases, piles, gastrointestinal disorders, small pox, hepatitis, tumor, HIV, ulcers and ringworm. The review covered literature available from 1959 to 2020 collected from books, scientific journals and electronic searches, such as Science Direct, Web of Science and Google scholar. Various keywords, such as Mimosa, secondary metabolites, medicines, phytochemicals and pharmacological values, were used for the data search. The Mimosa species are acknowledged to be an essential source of secondary metabolites with a wide-ranging biological functions, and up until now, 145 compounds have been isolated from this genus. Pharmacological studies showed that isolated compounds possess significant potential, such as antiprotozoal, antimicrobial, antiviral, antioxidant, and antiproliferative as well as cytotoxic activities. Alkaloids, chalcones, flavonoids, indoles, terpenes, terpenoids, saponins, steroids, amino acids, glycosides, flavanols, phenols, lignoids, polysaccharides, lignins, salts and fatty esters have been isolated from this genus. This review focused on the medicinal aspects of the Mimosa species and may provide a comprehensive understanding of the prospective of this genus as a foundation of medicine, supplement and nourishment. The plants of this genus could be a potential source of medicines in the near future.

Changes in pelvic floor mobility in uncomplicated pregnant women over 28 gestational week and its relation with subjective urinary incontinence complaints

To describe the mobility of the anterior pelvic compartment and hiatal enlargement measures in pregnancy with urinary stress incontinence complaints and their relation to the perceived subjective urinary incontinence severity. Forty-six pregnant women were included in this observational prospective cohort study, the ultrasonographic parameters of the pelvic anterior compartment including hiatal anteroposterior (AP) diameter, retrovesical angle (RVA), bladder neck descent (BND), urethral rotation angle (URA) and cystocele level were compared with the subjective urinary complaints in healthy third trimester pregnant women. Hiatal AP diameter, RVA and BND on Valsalva did not significantly correlate with gestational week (p=0.292, r=0.096; p=0.079, r=0.159; p=0.901, r=0.011, respectively). Urethral rotation angle was significantly increased in women after 39th gestational week (p=0.037, t=-2.17). Hiatal AP diameter, BND and RVA on maximal Valsalva did not differ with estimated fetal weight above and below 3000 gr. Total severity and bother scores of the M-ISI scale was found as similar among women with open (&gt;1400) RVA and intact (&lt;1400) RVA (p=0.556 and p=0.779, respectively). Only nocturia frequency (β=.379, t=4.035, p=.000) positively predicted the incontinence severity score. The pelvic floor ultrasound parameters of the anterior compartment may not predict the subjective urinary incontinence severity in third trimester of pregnancy. Nocturia was found to contribute for subjective impaired urinary function. The idea of being pregnant may suppress the general complaints related with changes in pelvic floor mobility.

Effect of Transurethral Thermotherapy on Storage Symptoms Associated with Lower Urinary System Complaints in Elderly.

Storage symptoms are pathology with increasing frequency and importance among elderly men. The efficacy and advantages of the new bipolar radiofrequency prostate thermotherapy method were investigated for storage symptoms in elderly. The outcomes for 150 elderly patients with significant storage symptoms accompanying voiding symptoms were investigated. The patients' Qmax (maximum urinary flow rate), prostate volumes, OAB-V8 (overactivebladder-Validated 8) and quality of life scores were questioned before the procedure and 1st month and 6th month. OAB-V8 total score had mean value of 26.3, with values identified as 16.2 (p < 0.001) at the end of the 1st month and 13.9 (p = 0.001) at the end of the 6th month. There were significant reductions in daytime frequent urination, uncomfortable urgency and sudden feeling of urgency complaints (p < 0.001). Thirty-five patients had significant fall in urgency with incontinence (p = 0.016). The bipolar radiofrequency thermotherapy method provides significant improvement of storage symptoms in elderly men. It is thought that this method has advantages in terms of its effects on storage and voiding symptoms in the elderly.

The efficacy of music therapy in lowering intraoperative sedative requirement and recall of intraoperative processes by patients under spinal anesthesia

Background: This music therapy was found to be a potent and efficient means of strategy for the treatment of illness in all the health aspects. It modifies the normal body's flight and fight response to stress during surgeries. It is a unique approach for relieving patients, making them stress-free without any means of side effects. Methods: This prospective comparative observational study includes a total of 50 cases, randomly assigned in 2 sets of 25 each in age (20–60 years), lower abdomen, urinary complaints related to surgeries, etc. under spinal blockade. These patients were assigned randomly to Group M (music group) and Group C (nonmusic group). Midazolam was given for sedation in both the groups with the aim to achieve Observer's Assessment Sedation/Alertness Score (OAS)-3 or less and to calculate and compare midazolam (total dose) requirement. After giving spinal to the patient and achieving desired levels, the patients were given headphones and the music was set up n music group patients. Basic vitals and requirements (total sedative) during surgery were recorded and then compared between the two groups. The ability of the patient to recall intraoperative events after surgery was also calculated by 6-point questionnaire, and for assessing pain severity, the visual analog scale score method was used. Results: We have found that intraoperatively, midazolam requirement (total) was found to be very low in the patients who listened music (P < 0.01), the OAS score was better in the music group, and the systolic and diastolic blood pressure and pulse rate may be comparable in both the groups. Conversations between doctors/nurses, OT staff during surgery, and monitors sound, instruments, etc., were more significantly recalled by a group of people who do not listen to music intraoperatively. Conclusion: Our study concluded that the use of intraoperative music in patients under spinal anesthesia can be demanding therapy by reducing patient's requirement of medication, needed for sedating them and relieving pain. This helps in creating an effective, safe method for patient's overall satisfaction.

Undetected prevalence of urinary incontinence among middle-aged women and its association with quality of life

INTRODUCTION: The study was conducted to determine the undiagnosed prevalence of urinary incontinence and its association with the quality of life in middle-aged and older women. METHODS: The sample of the study consisted of women aged 40 years or above who were admitted to a tertiary care center between March and July 2019. The data were collected by face-to-face interview method. “International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)” and “Incontinence Quality of Life Questionnaire (I-QOL)” were used to collect data on urinary incontinence and quality of life. RESULTS: The screened sample included 140 women (mean age: 60.6 ± 11.3 years). Urinary incontinence was detected in 90 subjects (64.3%). Urinary incontinence complaints were present for an average of four years. Self-rated effect on daily life was moderate (ICIQ-SF: 5.0 ± 2.5), and more than half of them (64.4%) did not consider urinary incontinence as a health issue, More than half (62.9%) did not admit for prefossional care for many reasons. The average score was 85.0 ± 14.7 from the

Pharmacotherapeutic options in the treatment of nocturia: an update on the current oral drug therapies

ABSTRACT Introduction Nocturia is a common urinary complaint among patients presenting with lower urinary tract symptoms and in recent years, there is a greater emphasis to tailor the treatment for nocturia in a more holistic and multidisciplinary manner given the potential multifactorial causes for nocturia. Areas covered Current oral drug therapies can be classified into three main groups, namely, decreasing polyuria, targeting bladder capacity, and improving sleep-wake and circadian rhythm. The authors focus this article on these oral therapies and provide their expert opinion. Expert opinion Treatment strategies should always involve lifestyle changes and behavioral modifications, with the targeted treatment of underlying medical conditions that may cause nocturia. Desmopressin remains the only drug approved specifically for the treatment of nocturia. Medications targeting the bladder and prostate can have secondary benefits in minimizing nocturnal frequency and urgency especially if the drug is taken at nighttime. Treatment of an underlying sleep disorder or circadian disorder can often help to increase total sleep time and quality, and perhaps reducing the nocturnal diuresis and nocturia episodes. Future studies in nocturia should improve the identification and diagnosis of underlying mechanisms that lead to nocturia, so treatment can become more streamlined, while at the same time, explore the role of various pharmacotherapeutic agents and novel therapy to reduce or eliminate nocturia.

P099 READMISSIONS AND EMERGENCY ROOM VISITS FOLLOWING OUTPATIENT AND INPATIENT HERNIORRHAPHIES

Abstract Aim Analysis of all healthcare encounters (readmissions and emergency department visits, EDV) following both inpatient and outpatient abdominal hernia repairs (AHR), with respect to the timeline of such encounters. Material and Methods Patients undergoing AHR were identified in Maryland State Inpatient and State Ambulatory Surgery and Services Databases, 2016-2017, and all their hospital and ED encounters were assembled into a comprehensive database, covering almost 95% of all AHR performed in Maryland. Results Of the total 26,215 patients who underwent AHR (3,333 inpatient and 22,950 outpatient; 48.7% inguinal and 53.0% ventral/umbilical), 5,802 (22.1%) had at least one postoperative encounter (4,186 EDV, 1,415 readmissions, and 248 encounters for mostly outpatient another AHR). 419 (80.4%) post-operative encounters within the first 48 hours were EDV and 98 (18.8%) were readmissions. Fraction of EDV within later encounters was in 69.6–71.1% range. Most frequent reasons for EDV were urinary complaints (24.1%, 10.6% and 4.0% on POD 0–2, 3–7, and 8–30, respectively), followed by pain control issues (18.1%, 24.9%, 14.4%) and delayed return of bowel function or constipation (10.5%, 9.9%, 3.4%). Readmissions mainly occurred for aforementioned GI complaints (15.3%, 19.9%, 6.9% on POD 0–2, 3–7, and 8–30, respectively), local surgical site infections (5.1%, 15.5%, 26.8%), and respiratory complications (8.2%, 6.6%, 4.1%). Conclusions 2.3% of all patients had at least one readmission while 6.4% patients had at least one EDV within 30 days following herniorrhaphy. Early postoperative EDV were mainly caused by urinary complaints, inadequately controlled pain, or delayed bowel function. Factors associated with these largely preventable complications require dedicated analysis.

\u2018As long as I have a restroom somewhere [\u2026], I am fine\u2019: a qualitative study on the perspectives of peri- and postmenopausal women on the impact of the urinary component of the genitourinary syndrome of menopause (GSM)

BackgroundOur aim was to gain insight into the experiences of women suffering from the urinary component of the Genitourinary Syndrome of Menopause (GSM) and to understand the impact of urinary complaints as part of GSM on the lives of affected women.DesignQualitative study.SettingOnline, primary care.Participants and methodsPostmenopausal women aged from 46 to 85 years reporting vaginal and urinary complaints were recruited to participate in either online or face-to-face focus groups to share their experiences with urinary complaints as part of GSM. Transcripts of sessions were analysed using qualitative content analysis.ResultsOne online focus group, one face-to-face focus group and one online-interview were conducted, involving 11 women. Five a priori assumed main themes related to the impact of urogenital symptoms were identified: daily life, emotional well-being, sexual functioning, self-concept and body image, and interpersonal relations and communication. Additionally, two further themes associated with GMS as a clinical condition were inductively found: unmet healthcare needs, including expectations of affected women regarding menopausal symptoms and a lack of adequate health education, and aspects on the personal dealing with the complaints, including personal coping strategies and medical treatment.ConclusionsThis study showed that urinary complaints as part of GSM have, similar to vaginal complaints, negative impacts on the daily life, the emotional well-being, the sexual functioning, the self-concept and body impact as well as interpersonal relations and communication of affected women. We further identified several unmet healthcare needs that should trigger improvements in healthcare.

Meatal Stenosis and Atopic Condition: A Pilot Study Demonstrating a Possible Unidentified Etiology.

Meatal stenosis (MS) is known as one of the most frequent complications of circumcision. In the present study, we aimed to find any possible relationship between MS and allergic disorders. A total of 36 children with a mean±SD age of 5.84±2.03 years were referred with MS and an atopic background even in themselves or in one of their family members (Group A). There were also age-matched controls with a mean±SD age of 5.70±2.17 years who were referred to our center with allergic symptoms and no urinary complaints (Group B, n=17). The RIDA qLine allergy and allergy explorer (ALEX) tests were performed for all patients to find possible allergen sensitization. Laboratory findings revealed that IgE-sensitization to the main food and aeroallergens in Group A (with the chief complaint of MS in whom a mild atopic condition was found during concise medical history taking) were very similar to the control group with no significant difference (except for ryegrass which was higher in the control group). Although total IgE level was considerably higher in group B compared to group A, food sensitization to cow's milk and ß-lactoglobulin was higher in asthmatic patients of group A compared to the controls. It seems that not all patients with MS should be considered as a complication of circumcision and undergo a surgical procedure for correction of the stenosis. Further investigations are required to determine the role of concise medical history taking and proper treatment of the allergic disorder to reduce failed surgical attempts in atopic boys with MS.

952 When A Surgeon Was Called to The Obstetric Unit: A Rare Case of Gonococcal Peritonitis in A 12-Week Pregnancy

Abstract Background Primary bacterial peritonitis presenting as septic shock is infrequently seen in clinical practice. This is a case of gonococcal peritonitis presenting as septic shock in a pregnant lady needing emergency laparotomy, drainage of purulent fluid and abdominal lavage. Case Presentation A 35-year-old woman presented with severe generalised abdominal pain. No history of fever, vomiting, urinary or bowel complaints. She was in her 4th pregnancy, at 12-weeks gestation. She was afebrile but tachycardic and hypotensive. Abdomen was tender and there was no vaginal bleeding. Ultrasound scan showed minimal fluid in hepatorenal area and a viable intrauterine pregnancy. Differential diagnosis were ruptured appendix, ectopic pregnancy, acute abdomen and shock. Exploratory laparotomy was done. Moderate amount of purulent fluid was noted within the abdominal cavity and no bleeding was seen. General surgeon was called for assistance by the Obstetrician as no foci of infection was found. The uterus, fallopian tubes, ovaries, appendix, bowel and upper abdominal organs were found to be intact. Peritoneal fluid culture was taken. Drainage of purulent fluid and peritoneal wash was done. She was nursed in ICU because of peritonitis with septic shock and AKI. Peritoneal fluid culture showed Neisseria gonorrhoea and IV ceftriaxone was given for 7 days. Postoperatively she recovered well but needed evacuation of uterus for a missed miscarriage. She was screened for other STIs and were negative. Discussion Gonorrhoea is the second most common reported STI. It can present as acute peritonitis when the infection has spread beyond upper reproductive tract organs.

A Rapidly Enlarging Ovarian Cyst in a Pregnant Patient: The Surprise

Introduction: More than 90% of ovarian tumors during pregnancy are less than 5 cm in size and are generally absorbed spontaneously before the 16th week of pregnancy. A big, rapidly enlarging ovarian tumor during pregnancy is an extremely rare finding and when present, should raise suspicion for malignancy. We present a case of a rapidly enlarging ovarian mass that, surprisingly, turned out to be a benign tumor. Case Presentation: 23-year-old pregnant, G3P1101, at 13 weeks of pregnancy, that came to the emergency department for evaluation of abdominal pain. Patient reported she was experiencing a left lower quadrant abdominal pain. Pain was cramping, and was radiating to the back. No vaginal bleeding, nausea, vomiting or urinary complaints associated with it. Abdominal exam demonstrated a gravid uterus, and a soft abdomen with mild left pelvic tenderness to palpation. Initial pelvic ultrasound (US) showed a single live intrauterine pregnancy along with a 9.6 cm thin walled anechoic left ovarian cyst (Image 1). At 22 weeks of gestation, her uterine height was noted to be much greater than expected for her gestational age and repeat US showed the cyst was 13 cm in size (Image 2). Subsequently, ultrasound done at 26 weeks of gestation showed a left ovarian cyst of 18 cm which contained a 7 cm multiseptated avascular daughter cyst (Image 3). CA 19-9, CA-125, and inhibin A were elevated. CEA and AFP were normal for this stage of pregnancy. After this, a transvaginal US showed a huge, complex cystic mass in the left adnexa measuring 21.6 cm, with a solid portion seen in the cranial aspect of the cystic mass. Because of the rapidly enlarging nature of this mass, a concern for malignancy was raised. Betamethasone was given for fetal lung maturation and patient underwent emergent exploratory laparotomy. A 20-cm left ovarian mass adherent to the retroperitoneum was found and removed. The pathology results were significant for a mucinous cystadenoma. The patient proceeded with the remainder of the pregnancy delivered a viable newborn at 40 weeks via spontaneous delivery. There were no complications following the delivery and both mother and baby are doing well. Discussion: There are many cases describing rapidly enlarging malignant tumors during pregnancy. But, there are not many cases describing rapidly enlarging benign tumors during pregnancy. Balci et al. published a series of 36 cases of pregnancies with adnexal masses, comprising patients over a 6-year period, and only 1 case of adnexal masses requiring surgery turned out to be a mucinous cystadenoma. The pathogenesis of mucinous cystadenomas and the mechanism by which these tumors may grow rapidly during pregnancy is unknown. A possible theory is that these tumors may be positive for hormonal receptors. However, there are cases of receptor-negative tumors that expand rapidly during pregnancy as well. More study is needed to understand the origin and mechanism by which these tumors may grow rapidly, as this is unknown and may have significant implications in terms of management. Conclusions: Even though a rapidly enlarging ovarian tumor during pregnancy may raise suspicion for malignancy, there is still a possibility to find a benign tumor. This is extremely rare, but, more study regarding these tumors is needed so that a timely management can be instituted to avoid miscarriages, intra-uterine growth restrictions, and other obstetrical complications.

Effect of bladder dysfunction on development of depression and anxiety in Parkinson's disease.

Parkinson's disease (PD) often presents with movement disorder. However, besides motor complaints, there are many complaints such as anxiety, depression, urinary complaints and constipation. The aim of this study was to investigate whether neurogenic lower urinary dysfunction (NLUD), which is frequently seen in PD, has an effect on the development of anxiety and depression in these patients. The study included 32 males (66.6%) and 16 females (33.3%); in total 48 subjects were registered. For the diagnosis and severity of PD, the UK Parkinson's Disease Society Brain Bank Criteria, Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn-Yahr scale were used. Urological evaluation was performed using history, physical examination, laboratory tests and standard forms such as IPSS and OAB-V8. There was no difference between the genders in terms of duration, severity and NLUD (p > 0.05). The incidence of anxiety and depression in PD patients was 62.8% and 72.1%, respectively. The prevalence of NLUD was 67.4% and depression and anxiety was found to increase (1.06 and 1.28 times, respectively) in relation to NLUD. In particular, there was a relationship between storage lower urinary tract symptoms and anxiety and depression development (p < 0.05). As expected, it was found that the incidence of NLUD, anxiety and depression was increased in PD. In addition, NLUD was found to be a risk factor for the development of anxiety and depression. Therefore, it is concluded that NLUD, which can potentially cause important complications, as well as motor complaints, should be closely monitored and treated in PD patients.