Urinary Complaints Research Articles

‘As long as I have a restroom somewhere […], I am fine’: 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)

Objective: Our 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.

MP02-10 MENHEALTH UROFLOWMETRY APP IS EQUIVALENT TO STANDARD OFFICE UROFLOWMETRY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-10 MENHEALTH UROFLOWMETRY APP IS EQUIVALENT TO STANDARD OFFICE UROFLOWMETRY Michal Tavrovsky, and Roger E. Schultz Michal TavrovskyMichal Tavrovsky More articles by this author , and Roger E. SchultzRoger E. Schultz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We compared standard Prometheus Office Uroflowmetry (POU) against the results obtained by a new MenHealth Uroflowmetry App (MUA). The MenHealth Uroflowmetry App (MUA) is a smart phone app that acquires and analyzes the sound of urine voided into a water filled commode. The program calculates maximum and average flow rates as well as volume voided. MUA can be downloaded by patients to their phones for use at home. METHODS: Only men were tested and all were older than 18 years. Group 1 included 47 volunteers with voiding symptoms suggesting overactive bladder and/or outlet obstruction. Group 2 included 15 men with no urinary complaints. Each participant conducted minimum 10 MUA measurements at home and two standard POU tests in our office. Maximum and average flow rates were recorded, as well as voided volume.A comparison of averaged results of MUA and POU was performed using a Bland-Altman analysis and a Passing-Bablok non-parametric regression analysis. Eight participants were excluded from this analysis - four men who did not operate the MUA properly (data was uninterpretable) and four men who could not properly perform the standard POU. A total of 54 participants (43 in Group 1 and 11 in Group 2) were reviewed. RESULTS: Pearson Correlation coefficient R and correlation coefficient R2 during regression data analysis indicated a very strong correlation and fit between Max Flow rate and Average Flow rate when comparing MUA to POU. Slope value close to 1 indicates practically identical sensitivity to flow using both methods. Insignificant difference in mean Max and Average flow rates for Groups 1 and 2 (<0.5ml/s) also proves strong correlation between the two methods and the accuracy of MUA. Statistical analysis also shows no significant difference between the two measurement methods. Figure comparing Max flow rate between the two methods is shown. CONCLUSIONS: The “at home” use of MUA is equivalent to PUO for men with and without voiding symptoms. MUA may be advantageous for the study of men who may not void well in the office because of low urine volume or bashful bladder. MUA permits repetitive measurements without the need for an office visit. Data can be easily transmitted by phone. A few men are challenged by the use of this smart phone App, but more detailed instruction should help minimize any confusion. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e15-e15 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michal Tavrovsky More articles by this author Roger E. Schultz More articles by this author Expand All Advertisement Loading ...

Gender-Related Differences in Prodromal Multiple Sclerosis Characteristics: A 7-Year Observation Study.

Increasing evidence supports the observation that multiple sclerosis (MS) has a preclinical period, with various prodromal signs and symptoms more frequently represented in patients with confirmed MS many years later. Considering the apparent gender differences in the incidence and clinical course of MS, it remains unclear whether it could be reflected in prodromal symptom features. This study aimed to compare a broad spectrum of prodromal signs and symptoms between males and females in the 7-year period before the definite diagnosis of MS. Data came from the central register of the national payer of services, financed under the public healthcare system in Poland. They covered a 7-year period of patient health record claims, from 2009 to 2016. The following groups of symptoms were significant with women: musculoskeletal (p < 0.001), ophthalmic (p < 0.001), laryngological (p < 0.001), digestive system (p < 0.001), urinary tract (p < 0.001), mental (p < 0.001), cardiovascular (p < 0.001), complaints and headaches (p < 0.001). There was also a weak correlation with head injuries (p = 0.03) while dermatological and reproductive system complaints did not appear to be significant (p < 0.05). For males, the following groups of symptoms were significant: musculoskeletal (p < 0.001), ophthalmic (p < 0.001), laryngological (p = 0.007), cardiovascular system symptoms (p < 0.001), and headaches (p < 0.001). Interestingly, reproductive system problems were overrepresented in the male population (p = 0.008). There was no significant correlation with MS risk for dermatological, digestive, urinary, and mental complaints. Similarly, head injuries were not significant. Our results shed more light on well-known differences in the epidemiological and clinical characteristics between sexes in multiple sclerosis, and show differences in prodromal complaints before MS onset.

Tablet and capsule formulations incorporating high doses of a dry optimized herbal extract: The case of Satureja kitaibelii

Aerial parts of Satureja kitaibelii are traditionally used as carminative, for treatment of respiratory and urinary complaints, or as anti-inflammatory agent for skin and mucous membranes. The aim of the present study was to formulate immediate-release capsules and tablets with high content (≥95%) of S. kitaibelii optimized dry extract by direct compression. The influence of ethanol concentration (40–96%, v/v), temperature (25–80 °C) and time (2–8 h) on the extraction yield, total phenolic content (TPC), as well as on the contents of rosmarinic acid (RA) and clinopodic acid O (CAO) in the S. kitaibelii dry extract was investigated using the response surface methodology (RSM). The estimated optimal conditions for the extraction were: ethanol 46.4%, 61.6 °C, 2 h. Dry extract of S. kitaibelii obtained under the optimal conditions (characterized by: yield 24.2%, TPC 170.4 mg gallic acid equivalents/g, RA 10.7 mg/g and CAO 17.1 mg/g) was used to manufacture solid dosage forms. Three formulations (F) were prepared: F1, hard capsules (99% dry extract, 1% magnesium stearate); F2, uncoated tablets (99% dry extract, 1% magnesium stearate) and F3, uncoated tablets (95% dry extract, 4% sodium starch glycolate, 1% magnesium stearate). Hard capsules (F1) with the uniform weight, adequate disintegration time and dissolution rate were obtained. Regarding tablet formulations, F3 exhibited satisfactory tableting properties, disintegration time and dissolution profile. Therefore, immediate-release capsules and tablets with a high content of S.kitaibelii extract were formulated to accomplish the unmet need for convenient solid dosage forms that contains high doses of herbal extracts.

Retroperitoneal unicentric Castleman's disease—A case report and review of literature

Introduction and importanceCastleman's disease is not so commonly diagnosed worldwide due to non-specific symptoms Clinical findings are variable.No definite blood investigation or any biomarkers are established to diagnose this disease. Radiological investigations do not play much role in diagnosing. It can be unicentric or multicentric. Etiological factors are not well understood except predilection of this disease towards immune-compromised persons. Surgery is considered as a prime modality to treat, if resectable.Case presentationPatient had recurrent abdominal pain in left lumbar region which was intermittent for last 6 months, dull aching with no aggravating and relieving factors. There was no history of abnormal bowel habits, urinary complaints, fever, night sweats, weight loss, rashes in body, joint pains and loss of appetite. On examination, there was a single, firm, non-tender, intra-abdominal, retroperitoneal mass of approximately size 10 ∗ 7 cm in left lumbar region encroaching inferiorly towards left inguinal region. Digital rectal examination (DRE) and external genitalia were normal.Clinical discussionAll routine blood investigations along with relevant tumour markers were normal. Magnetic Resonance Imaging (MRI) abdomen showed a well-defined mass suggestive of stromal tumour or retroperitoneal sarcoma. Patient underwent surgery in which complete excision of the mass was done. Postoperative event was uneventful and currently doing well.ConclusionTake away lesson in this case report is that we should not presume all retroperitoneal mass as cancer or sarcoma, we have to think about other rare causes like Castleman's disease, if clinical picture, blood and radiological investigation are discordant.

A prosztatarák kezelésében alkalmazott besugárzási technikák vizelési képességre gyakorolt korai hatása

Various radiotherapy procedures are applied in the treatment of prostate cancer. Nevertheless, their early and late side effects measured by uroflow and residual volume measurements have not been studied extensively. We investigated by objective methods the early changes of urination ability after different radiotherapy procedures. According to the protocol defined in our study, all patients had their IPSS (international prostate symptom score) determined, as well as their uroflow examinations and measurements of their residual urine via suprapubic ultrasound, carried out before treatment. These tests were then repeated at 4-6 weeks after the end of their radiotherapy. A total of 26 patients were included in the study. 6 patients were treated with low-dose rate (LDR) brachytherapy and 5 patients with high-dose rate (HDR) brachytherapy, 12 patients with Cyberknife (CK) using extreme hypofractionation and 3 patients with moderately hypofractionated radiotherapy with a linear accelerator (LINAC). Due to the similarity of the treatments, the LDR and HDR groups together were also studied as brachytherapy group and the CK and LINAC patients as teletherapy group. We found that the early deterioration of IPSS and uroflow parameters after brachytherapy were significant (IPSS irritative symptoms: p = 0.003, IPSS obstructive symptoms: p = 0.011, maximum flow: p = 0.003, mean flow: p = 0.006), while in teletherapy only the IPSS irritative symptoms worsened significantly (p = 0.011). Based on our results, we suggest to perform uroflow examination and IPSS test before selecting therapeutic modality for patients with prostate cancer. In patients with moderate or severe urinary complaints before the treatment, we recommend to use teletherapy rather than brachytherapy. Orv Hetil. 2021; 162(33): 1328-1334.

A Rare Case of Pseudotumoral Ureteric Tuberculosis Causing Forniceal Rupture

A 55-year-old woman, with no medical history, presented with acute right flank pain. She had no history of other urinary complaints. On physical examination, the patient was tachycardic (pulse rate: 100bpm) and tachypneic (respiratory rate: 24 breaths/min), blood pressure was11/6 and temperature was 37.4°. The abdominal examination showed severe tenderness in the right flank and the right iliac fossa. All blood reports were normal, including C-reactive protein, cell blood count and serum creatinine. Computed Tomography of the abdomen revealed a right hydronephrosis with delayed phase contrast leak and a retroperitoneal mass of 48x36mm of unknown nature, enhanced after contrast injection, which seemed to compress the right ureter causing the forniceal rupture. A double J ureteral stent was insterted into the right renal cavities with favorable evolution and immediate resolution of pain. Surgical management of the mass was scheduled one month later after the inflammatory phase and resorption of the urinoma. The patient underwent an exploratory laparotomy. Intraoperatively, a tissular retroperitoneal mass of 4 cm was discovered which invadedthe right proximal ureter as well asthe duodenum and the ileocecal pedicle (Figure 1). Resection of the tumor was performed as well as a segmental ureterectomy, right colectomy, and resection of a small portion of the duodenum. Both ureteric and colic anastomosis were then performed along with duodenal suture. The post operative course was uneventful.

The prevalence of urinary incontinence and its relationship with physical and cognitive status in older adults: Results of the Crystal and the Eucalyptus studies

BACKGROUND: Urinary incontinence worsens the psychological state of older adults, increases the risk of developing anxiety, depression, falls-related injuries, leads to a decrease in the quality of life, and a decrease in the level of physical activity in old age.&#x0D; AIM: To assess the prevalence of urinary incontinence according to the data of the Crystal and Eucalyptus studies, to identify factors associated with the development of urinary incontinence, as well as factors that reduce the risk of urinary incontinence in old age.&#x0D; MATERIALS AND METHODS: A random sample of 1007 people aged 65 and older. The main parameters: urinary incontinence, frailty, nutritional status, anemia, CRP, functional status, depression, dementia, chronic diseases, grip strength, level of physical functioning, falls. The observation time is 2.5 years.&#x0D; RESULTS: According to the Eucalyptus study, urinary incontinence syndrome was detected in 48.0%, in the Crystal study in 41.2%. In 62.4% cases urinary incontinence was diagnosed for the first time. Urinary incontinence was associated with a higher prevalence of COPD, history of stroke, sensory deficits, frailty and other geriatric syndromes. Improved nutrition and increased protein intake led to the disappearance of urinary incontinence complaints in 47.7% of cases. The disappearance of complaints of urinary incontinence was associated with an improvement in the emotional status. A decline in cognitive function has been associated with an increased risk of urinary incontinence in old age.&#x0D; CONCLUSIONS: Despite the high prevalence of urinary incontinence, it often remains undiagnosed. The correct wording of the question in the conversation with the patient allows to identify 30% more cases of urinary incontinence. Given the high prevalence of urinary incontinence among patients with COPD, stroke, sensory deficits, frailty and other geriatric syndromes, all patients in these groups should be purposefully asked about the presence of symptoms of urinary incontinence. Improved nutrition and increased protein intake are associated with the disappearance of urinary incontinence complaints.

Large Retroperitoneal Perivascular Epithelioid Cell Neoplasm (PEComa): A Case Report and a Brief Review

Objective: To describe a case of retroperitoneal perivascular epithelioid cell tumor (PEComa) and to discuss the main features of this rare pathology. Introduction: PEComas represent a rare cluster of neoplasms with uncertain origin; their precursor cells are spindle-shaped and characterized by a myomelanocytic phenotype, so only immunohistochemical staining makes a definitive diagnosis possible. To date, less than three hundred cases are reported in Literature and retroperitoneal site accounts for 7-8% of overall locations. Case Report: Middle-aged female has visited for abdominal pain and urinary complaints; physical findings and imaging demonstrated a huge inhomogeneous mass occupying right abdomen and arising from renal capsule. After multidisciplinary evaluation, patient has been addressed to open surgery and an en-bloc resection of the mass, with right nephrectomy and adrenalectomy. Immunohistochemical staining made a diagnosis of PEComa possible. After an uneventful postoperative stay, the patient entered a follow up protocol, without signs of local recurrence and distant metastases. Conclusion: Retroperitoneal PEComa often presents as a bulky mass with renal and adrenal involvement. Surgical resection should be aimed to obtain a complete removal with negative margins; this makes compartment surgery and en-bloc resection mandatory. Immunostaining is the key methods for a correct diagnosis.

Diagnostic Potential of Low Serum Platelet, Albumin and Prolong PT-INR for Overactive Bladder and Nocturia in Chronic Hepatitis-Related Liver Cirrhosis.

Overactive bladder (OAB) is defined as urgency, usually with frequency, nocturia, and incontinence. Patients with liver cirrhosis often present with urinary complaints. The possible reason for this is fluid redistribution, which may induce OAB resulting from portal hypertension and ascites. We conducted this study to investigate predictors of OAB in cirrhotic patients. A total of 164 patients with chronic viral hepatitis-related liver cirrhosis were enrolled and 158 (96.3%) completed the Overactive Bladder Symptoms Score (OABSS) questionnaire. Age, severity of liver cirrhosis, comorbidities, serum sodium level, use of diuretics, body mass index and renal function were also recorded. In the study cohort, the prevalence of OAB was 31.01% and the prevalence of urge incontinence (OAB wet) was 18.3%. Patients with an urgency score ≥2 in OABSS had a significantly lower platelet level (p = 0.025) regardless of the use of diuretics. In addition, 98 patients (62%) with nocturia and 29 patients (18%) with urge incontinence had significantly lower levels of serum albumin (p = 0.028 and 0.044, respectively). In conclusion, patients with liver cirrhosis have a high prevalence of overactive bladder. A low platelet and low serum albumin level in these patients may be predictors for overactive bladder. And longer PT-INR is also a possible biomarker for nocturia.

Functional outcomes rather than complications predict poor health-related quality of life at 6months after robot-assisted radical prostatectomy.

The objective is to evaluate the effect of robot-assisted radical prostatectomy (RARP)-related postoperative complications on the 6-month postoperative health-related quality of life (HRQoL). A total of 1008 patients underwent a RARP with or without pelvic lymph node dissection (PLND) between 2012 and 2020 and were invited to complete questionnaires about HRQoL and functional outcomes (urinary incontinence (UI), erectile dysfunction (ED) and urinary complaints (UC)) before and 6months after RARP. Patient characteristics and postoperative complications up to 90days after surgery were prospectively recorded. Associations between complications and HRQoL/functional outcomes were assessed by multivariate linear regression analyses. In total, 528 patients (52.4%) were included in the analyses. Complications occurred in 165/528 (31.3%) patients, of which 30/165 (18.2%) had a Clavien-Dindo ≥ III complication. In multivariate regression analyses, postoperative complications were not significantly associated with postoperative HRQoL, UI and ED (p = 0.73, p = 0.72 and p = 0.95, respectively), but were significantly associated with a minor increase in UC (β = 1.7, p < 0.001). More specifically, infectious and urological complications were significantly associated with an increase in UC (β = 1.9, p < 0.001 and β = 0.9, p = 0.004, respectively). The presence of UTI, in particular, was significantly associated with this minor increase (β = 1.5, p = 0.002). Functional outcomes were all significantly associated with the HRQoL at 6months postoperatively. No significant associations were found between postoperative complications and HRQoL at 6months after RARP. However, worse functional outcomes were associated with a worse HRQoL at 6months postoperatively. In addition, postoperative infectious and urological complications were significantly associated with a minor increase in UC.

Not the Postmenopausal Syndromes, Urinary Complaints are the Most Common Presentation of the Post-Menopausal Women

Postmenopausal estrogen deprived state causes various types of vasomotor symptoms, urogenital symptoms, and long-term health hazards. Among the postmenopausal women, this study was aimed to determine the prevalence of urogenital complaints, epidemiological studies relating with recurrent UTI, and to observe the changing pattern of bacterial resistance to commonly used antibiotics for UTI. This cross-sectional study was conducted in Faridpur, Bangladesh, from January-December 2019. Total 244 postmenopausal women attending the clinic with various complaints were selected as the study population. In-depth history, clinical examination, and relevant investigations were done. Urinary culture and sensitivity were done to isolate the causative organism and to identify the current antibiotic resistance and sensitivity pattern. Among the study population, 94.7% had urinary complaints as their first concern. However, upon query, 85.2% of them revealed that they had other postmenopausal syndromes. Among the study population, 43.4% had recurrent UTI. Burning micturition was the most common (79.2%) urinary complaint. On urinary culture, 57.5% cases had no growth; among the rest, the most common organism was E. coli (19.8%) followed by Proteus (12.3%) and Klebsiella (10.4%). In Proteus and Klebsiella isolates, a high number of resistances for Nitrofurantoin have been found (75% and 66.7% accordingly). Urinary complaints are the most common presentation of postmenopausal women attending the gynecology clinic. They are seeking treatment not to improve the quality of life with hormone replacement therapy (HRT), but getting rid of the pain of recurrent UTI. Faridpur Med. Coll. J. 2020;15(2): 85-91

DEEP PELVIC ENDOMETRIOSIS WITH URINARY BLADDER AND OVARIAN INVOLVEMENT: ORIGINAL CASE REPORT AND REVIEW OF LITERATURE.

Bladder Endometriosis is considered as a rare cause of Inltrating pelvic endometriosis presenting as a localized mass lesion along the urinary bladder wall with detrusor muscle involvement and ovarian endometrioma. We report a rare case of a deep pelvic endometriosis invading urinary bladder and ovary, presenting with primary infertility and urinary complaints. Imaging plays a crucial role and helps clinician in early diagnosis and evaluation of extent of endometriosis contributing to the preoperative planning and timely management.

Review Article on Traditional out look of Smilax zeylanica

Since time immemorial plants have been used for various needs such as food, fodder, construction, dyes and medicine. Smilax zeylanica L., belonging to the monocotyledon family Smilacaceae, is a dioecious climbing shrub with woody stem. The plant is used as a substitute for Sarsaparilla. In this review, we present updated information on the ethnobotanical uses, phytochemistry and pharmacological activities shown by S. zeylanica by referring standard flora, journal articles and various search engines. Whole plant or certain parts of the plant (leaf, root, rhizome, fruit and stem) are used ethnobotanically in several countries for several purposes such as fodder, vegetable and in the treatment of diseases like skin diseases, piles, dysentery, venereal diseases, rheumatism, toothache, arthritis, and urinary complaints. The plant is reported to contain many chemicals and diosgenin, smilagenin, β-sitosterol, hydroxytyrosol, squalene and sarsapogenin are few among the important phytochemicals. A number of bioactivities such as antimicrobial, cytotoxic, analgesic, anti-inflammatory, antidepressant, antioxidant, antidiabetic and anticonvulsant activities have been shown by the plant. Overall, it can be concluded that S. zeylanica is a plant which is extensively utilized ethnobotanically for various therapeutic applications and is shown to exhibit a range of bioactivities, the results of which justifies the ethnobotanical uses of the plant. Further, S. zeylanica can be screened for developing bioactive phytochemicals which can be used as lifesaving drugs.

Mirabegron to manage symptoms of interstitial cystitis / bladder pain syndrome: A stone for two birds?

Background: Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS) patients often experience lowered quality of life due to pain, urinary urgency, and increases in urinary frequency. Like many chronic pain disorders, IC/BPS is poorly understood and treatment unsatisfactory. Materials and methods: We prospectively monitored the effects on pain and urinary complaints, of mirabegron associated with amitriptyline, for randomly selected women with IC/BPS. Results: Twenty-five women were randomly selected to treat pain symptoms of IC/BPS and 12 followed up until the end of the study. All patients showed improvement on all questionnaires referring to pain IC/BPS symptoms and urinary storage symptoms. There was no statistically significant improvement in urinary frequency. Conclusions: We suggest that mirabegron can work controlling urinary urgency and pain of IC/BPS patients.

The role of routine follow-up visits of prostate cancer survivors in addressing supportive care and information needs: a qualitative observational study.

To understand the role of routine follow-up visits in addressing prostate cancer survivors' supportive care and information needs. We audio-recorded follow-up visits of 32 prostate cancer survivors. Follow-up visits were analyzed according to the Verona Network of Sequence Analysis. We categorized survivors' cues, concerns, and questions into five supportive care domains and divided the responses by the healthcare professionals into providing versus reducing space that is to determine whether or not the response invites the patient to talk more about the expressed cue or concern. Prostate cancer survivors mostly expressed cues, concerns, and questions (in the health system and information domain) about test results, potential impotence treatment, follow-up appointments, and (their) cancer treatment during follow-up visits. Survivors also expressed urinary complaints (physical and daily living domain) and worry about the recurrence of prostate cancer (psychological domain). Healthcare professionals were two times more likely to provide space on cues and concerns related to the physical and daily living domain than to psychological related issues. Follow-up visits can serve to address prostate cancer survivors' supportive care and information needs, especially on the health system, information, and physical and daily living domain. Survivors also expressed problems in the psychological domain, although healthcare professionals scarcely provided space to these issues. We would like to encourage clinicians to use these results to personalize follow-up care. Also, these data can be used to develop tailored (eHealth) interventions to address supportive care and information needs and to develop new models of survivorship care delivery.

Broad-Spectrum Antibiotics for Breast Expander/Implant Infection: Treatment-Related Adverse Events and Outcomes.

Despite best practices, infection remains the most common complication after breast reconstruction with expanders and implants, ranging from 2% to 29%. Empiric broad-spectrum antibiotics are frequently used in nonsurgical treatment of implant-associated infections in an effort to salvage the reconstruction. Pitfalls of antibiotherapy include adverse events, vascular access site complications, and drug resistance. Our goals were to describe management of implant infections with broad-spectrum antibiotics, review treatment related adverse events, and report on outcomes of therapy. A retrospective review was carried out to identify patients who were treated with intravenous (IV) antibiotics for periprosthetic infection. Patient characteristics, surgical details, and antibiotic therapy-related adverse events were collected. Eventual outcome related to expander/implant salvage was noted. A total of 101 patients (111 treatment episodes) were identified. Mean duration of antibiotic treatment was 18 days (range, 1-40 days). The most commonly used parenteral treatment was a combination of daptomycin with piperacillin-tazobactam (65%) or an alternative agent (16%). Fifty-nine percent of treatment episodes resulted in salvage of the expander or implant. Thirty-five percent treatment episodes were associated with 1 or more adverse events: diarrhea (12.6%), rash (10%), vaginal candidiasis (3.6%), agranulocytosis/neutropenic fever (3.6%), nausea (3.6%), urinary complaint (0.9%), myositis (0.9%), headache (0.9%), vascular line occlusion (1.8%), deep vein thrombosis (1.8%), and finger numbness (0.9%). No patients developed Clostridium difficile colitis. Five episodes (4%) needed discontinuation of antibiotics because of severe adverse events. The prosthesis was explanted in 3 of the cases of discontinued treatment. Our findings show favorable outcomes and well-tolerated adverse effects with broad-spectrum parenteral antibiotherapy for periprosthetic infection. However, every effort should be made to deescalate therapy by narrowing the spectrum or limiting the duration, to minimize adverse events and development of bacterial resistance. Treating surgeons need to carefully weigh benefits of therapy and be aware of potential complications that might necessitate discontinuation of treatment.

Frequency and Trends of Prostatic Diseases in a Subset of Karachi Population: A Retrospective Study

Background: Prostatic diseases are a leading cause of frequent urinary complaints in elderly males. The most common diseases include prostatitis, benign prostatic hyperplasia, and prostate cancer. This study aimed to determine the frequency of the prostatic diseases, their trend over the years, and the association of age and diagnosis. Methods: A retrospective descriptive study was conducted in Basic Medical Sciences Institute (BMSI) at Jinnah Postgraduate Medical Centre, Karachi. Data was collected from the histopathological files and all the cases diagnosed from 2014 to 2018 were included. Statistical analysis was done using SPSS with 95% confidence interval and p-value of ≤ 0.05 was considered significant. The Chi-square test was applied to find the association with age and year of diagnosis. Results: Total 163 prostate cases were documented from 2014 to 2018, out of which 98 (60.1%) were of benign prostatic hyperplasia, which was most commonly diagnosed in men aged, 61-70. Prostatic adenocarcinomas having Gleason scores 8-10 were frequent and commonly seen in men aged 51-60 years. An increasing trend (p-value=0.053) was observed in the diagnosis of these prostatic diseases within these five years. Conclusion: Benign prostatic hyperplasia is the most frequently (p-value=0.140) diagnosed prostatic disease in men, followed by adenocarcinoma and prostatitis. Advanced stage prostatic adenocarcinoma was diagnosed more frequently 17(10.4%) and at an earlier age. There is an increase in the number (p-value=0.053) of cases of prostatic diseases diagnosed each year. National-level studies and health policies are needed to facilitate early diagnosis and treatment.

Epidermoid cyst of the clitoris

An epidermoid cyst is a benign cyst resulting of implantation of superficial epidermal tissue into the dermis or subcutaneous tissue. They are commonly found on the scalp, face, neck, trunk and extremities; and rarely seen in the clitoral or vulvar region, most often associated with prior trauma or surgery to the area, particularly female genital mutilation. Epidermoid cyst of the clitoris is a very uncommon pathological entity, it can be spontaneous present at birth or develop later in life, or often secondary to surgery or trauma at the clitoral region. Herein, we report a case of 33-year-old multiparous woman, without past medical history of vulvar trauma or genital surgery, presented to the emergency department with a history of slowly growing clitoral mass over 11 months, which recently became responsible of sexual discomfort and difficulty in urination, without fever, vaginal discharge or other complaints. On perineal examination a painless midline cystic mass of 5 A— 3 cm was noted; it extended from the clitoral region up to the labia minora; the mass was mobile, nontender, well-circumscribed and with a smooth surface (A, B). The labia minora and majora were normal, and both the urethral and vaginal openings were normal in position and shape (B). There was no associated bleeding or discharge. The remainder of the physical examination was otherwise unremarkable. Ultrasound testing revealed normal internal genital and urinary tract without communication between the cystic structure and the urethra. The patient underwent a complete surgical excision of clitoral cyst under spinal anesthesia, without compromising the clitoral neurovascular bundle or hood. Histopathological examination revealed an epidermoid cyst lined with stratified squamous epithelium and filled with keratinous material. The final pathologic diagnosis was of a spontaneous nontraumatic epidermoid cyst of the clitoris. The patient´s postoperative course was completely uneventful and she was discharged from the hospital on the 2nd postoperative day without any complication. No recurrence of the cyst was noted 6 months later at a follow-up visit, and she had a normal cosmetic appearance of the external genitalia, with complete disappearance of genital and urinary complaints.

Complete Labial Fusion in Postmenopause

Labial adhesion is defined as flimsy or dense fusion of labia minora in the middle which may be congenital or acquired. These adhesions are usually seen in prepubertal girls but rarely in postmenopausal women. Management options include topical estrogen with or without steroids or surgery in persistent circumstances. The case reported here was an 83-year-old postmenopausal woman who was presented with urinary retention and recurrent urinary tract infections. On examination, she had complete labial fusion leaving only a pinhole opening for voiding. A surgical approach was performed via a midline incision and complete excision of bilateral labia minora. Her urinary complaints were dissolved. Surgical management options for postmenopausal complete labial fusion cases will be discussed.