Urinary Tract In Patients Research Articles

Congenital Anomalies of the Kidney and Urinary Tract in Patients with Hirschsprung Disease.

To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease. An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022. All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant. Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis. Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT. Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

Congenital Anomalies of the Kidney and Urinary Tract in Patients with Hirschsprung Disease.

To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease. An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022. All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant. Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis. Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT. Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

Осложнения и нарушения мочеиспускания после проведенного оперативного лечения ДГПЖ методом лазерной энуклеации.

Introduction. Benign prostatic hyperplasia (BPH) is a common disease in elderly men, manifested by symptoms of the lower urinary tract. Drug treatment of BPH often allows you to delay or even avoid performing surgery. Laser endoscopic enucleation, which shows excellent functional results regardless of the patient's age and prostate volume, can be considered the modern «gold standard» of surgical treatment of BPH. However, complications and urinary disorders after surgical treatment are also inherent in this method. The purpose of this article was to systematize information on the quality of urination and the preservation of symptoms of the lower urinary tract in patients after endoscopic enucleation of BPH. Materials and methods. The literature review was compiled from analyzed materials from three scientific databases (PubMed, Scopus and Web of Science, eLibrary), focusing on the following keywords: «laser enucleation», «lower urinary tract symptoms», «complications after enucleation of prostate». Results. The obtained results of many studies allow us to state the existence of a new «gold standard» of surgical treatment of BPH and to consider the possibility of introducing HoLEP into the standards of medical care for urological patients with BPH. In the postoperative period, long-term monitoring of patients is necessary. Currently, there are no clear standards for the necessary examinations and the timing of their implementation in the postoperative period. Conclusion. Laser enucleation is a reliable method of surgical treatment of LUTS due to BPH.

Urinary disorders in patients diagnosed with organic brain pathology

Introduction. This study is relevant due to the high prevalence of organic brain pathology and the negative influence of urination disorders on the quality of life.Objective. To analyse the impaired function of lower urinary tracts in patients with organic brain pathology.Materials & methods. We analysed 607 patients with severe organic brain pathology (105 had traumatic spinal cord injury (TSCI) and 457 had consequences of acute stroke (AS)). We performed clinical urological examinations. During the survey, attention was paid to the presence of urinary tract pathology at the examining time and anamnesis. Structural changes in the urinary tract were objectively assessed. We objectively assessed structural changes in urinary tracts including prostate adenoma in men, insufficiency of pelvic floor muscles in women and strictures of the urethra or ureters. The degree of the spastic syndrome was assessed with the Ashworth Scale. The neurourological examination included cystometry with the measurement of bladder volume and post-void residual urine. The cognitive status of the patients was assessed with the MMSE (Mini-Mental State Examination) questionnaire. The correlation analysis between the degree of spastic syndrome measured with the Ashworth Scale and urination disorders was performed with Spearman rank correlation.Results. All patients had neurogenic dysfunction of the lower urinary tract. A combination of bladder retention and emptying disorders was found in 62 men older than 45yo with benign prostate hyperplasia (10,2% of all cases). An impaired accumulation function in history was found in 45 women older than 45yo (7,4% of all observations). The level of spasticity was 3 or 4 points on the Ashworth Scale in patients with TSCI and 2 to 4 points in those with AS. The analysis of correlations between the degree of spasticity and urination disorders showed a moderate relationship (r = 0,4) in patients with TSCI and a medium relationship (r = 0.65) in patients with AS.Conclusion. Neurogenic dysfunction of the lower urinary tract accompanies patients with severe organic brain pathology throughout their life and requires adequate correction.

Mortality from prostate cancer in the years 2007–2021 in North Rhine-Westphalia, Germany

BackgroundThe crude mortality rate and the lifetime mortality risk from prostate cancer in Germany are above international average. However age-standardised mortality and years of life lost per capita from prostate cancer are declining. This study analyses the mortality-related measures for the federal state of North Rhine-Westphalia (NRW) in Germany.MethodsBased on the cause of death statistics and data from the NRW State Cancer Registry on 45,300 deaths in the years 2007–2021, mortality rates, the lifetime mortality risk from prostate cancer, median age at death and years of life lost are presented. Additionally, the 15 most frequent causes of death of 95,013 patients diagnosed with prostate cancer are reported.ResultsWith a stable lifetime mortality risk from prostate cancer, age-standardised mortality and years of life lost per capita are decreasing while crude mortality and median age at death are increasing in NRW. Less than half of the patients die from their prostate cancer. Cancers of the urinary bladder and other urinary organs also occur more frequently as a cause of death than it would be expected based on the age-specific risk in the total population.ConclusionsMore people in North Rhine-Westphalia are dying of prostate cancer over time due to demographic ageing alone. At the same time, the age-specific mortality risk has not increased and when patients die of prostate cancer, it is at an increasingly older age. However, there is a statistical association with deaths from cancers of the lower urinary tract in patients diagnosed with prostate cancer, which demands further evaluation.

Neurogenic dysfunction of the lower urinary tract in infectious and inflammatory diseases of the spine: is there a correlation with clinical and radiological variants of myelopathy? Preliminary result of the analysis of a single-center cohort

Objective.To study the relationship between clinical and radiation variants of myelopathy and types of the neurogenic dysfunction of the lower urinary tract in patients with infectious spondylitis.Material and Methods.A single-center cohort observational study was conducted with the analysis of medical records and a prospective examination of 20 patients with infectious spondylitis complicated by neurogenic dysfunction of the lower urinary tract.Results.Infectious spondylitis can be complicated by the development of various urodynamic disorders, including neurogenic detrusor hyperactivity (30 %), its combination with detrusor-sphincter dissinergia (30 %) and a decrease in detrusor contractility (40 %). In 50 % of patients, an urodynamic examination revealed an increase in detrusor pressure of more than 40 cm water. There was no connection between the development of any type of lower urinary tract dysfunction and MRI types of myelopathy according to Vendatam, as well as between the level of spinal cord compression and the severity of neurological disorders according to AIS.Conclusion.The results of the study do not confirm the existence of a relationship between the various characteristics of myelopathy in infectious spondylitis and the results of urodynamic examination. The limitation of the reliability of the results is the small number of observations. Studies with a larger sample are required to assess the relationship between the clinical and radiation characteristics of myelopathy and variants of neurogenic dysfunction of the lower urinary tract in patients with infectious spondylitis.

Yeast Deletomics to Uncover Gadolinium Toxicity Targets and Resistance Mechanisms.

Among the rare earth elements (REEs), a crucial group of metals for high-technologies. Gadolinium (Gd) is the only REE intentionally injected to human patients. The use of Gd-based contrasting agents for magnetic resonance imaging (MRI) is the primary route for Gd direct exposure and accumulation in humans. Consequently, aquatic environments are increasingly exposed to Gd due to its excretion through the urinary tract of patients following an MRI examination. The increasing number of reports mentioning Gd toxicity, notably originating from medical applications of Gd, necessitates an improved risk-benefit assessment of Gd utilizations. To go beyond toxicological studies, unravelling the mechanistic impact of Gd on humans and the ecosystem requires the use of genome-wide approaches. We used functional deletomics, a robust method relying on the screening of a knock-out mutant library of Saccharomyces cerevisiae exposed to toxic concentrations of Gd. The analysis of Gd-resistant and -sensitive mutants highlighted the cell wall, endosomes and the vacuolar compartment as cellular hotspots involved in the Gd response. Furthermore, we identified endocytosis and vesicular trafficking pathways (ESCRT) as well as sphingolipids homeostasis as playing pivotal roles mediating Gd toxicity. Finally, tens of yeast genes with human orthologs linked to renal dysfunction were identified as Gd-responsive. Therefore, the molecular and cellular pathways involved in Gd toxicity and detoxification uncovered in this study underline the pleotropic consequences of the increasing exposure to this strategic metal.

Detection of Some Virulence Factors of Staphylococcus Aureus Isolated from Urinary Tract Patients in Kirkuk City, Iraq

This study included isolating and diagnosing Staphylococcus aureus in those who diagnosed with urinary tract Infection. In this study 200, sample were collected: (100 males and 100 females). The Isolates were diagnosed based on phenotypic and microscopic characteristics and biochemical tests. In addition, the confirmatory test was conducted using API 20 staph system and 38 Isolates were obtained (23 from females and 15 from males). Some virulence factors of S.aureus Isolates were studied. These studies showed that 76.31% of the Isolates were able to produce DNase, and all isolates were bioflim-producers. The results of the isolates production of hemolysin were that 65.78% caused a full Hemolysis. Also, the ability of bacterial isolates to produce broad-spectrum beta-lactamase enzyme was studied and its production rate was 55.26% and the ability of isolates to adhering was 81.57%.

Dysfunctions of the lower urinary tract in patients with multiple sclerosis. Pathogenesis, symptomatics, diagnosis

Multiple sclerosis is a chronic autoimmune demyelinating disease, one of the most common symptoms of which are urinary disorders. The review article provides information on the epidemiology, pathogenesis, symptoms, clinical course and diagnostic features of neurogenic dysfunctions of the lower urinary tract in patients with multiple sclerosis. Attention is drawn to the need for early diagnosis of urinary tract dysfunctions, which predetermines the timely initiation and effectiveness of treatment.

Detection of Extended Spectrum Beta-Lactamase (ESBLs) among Urinary Tract Patients in Khartoum State, Sudan

Background: Many different organisms can cause urinary tract infections, but Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus saprophyticus are the most prevalent ones. 60% of all antibiotics used to treat infectious diseases around the world are beta-lactam antibiotics, one of the main classes used to fight gram-negative and gram-positive bacteria. Objective: The purpose of this study is to detect and isolate Extended-Spectrum Beta-Lactamases (ESBLs), which are responsible for urinary tract infections, as well as check for any potential medication resistance. Materials and Methods: The gram stain technique and biochemical assays were used to identify 100 urine samples from Khartoum state hospitals based on their cultural characteristics and morphological appearance. Using the disk diffusion method, the isolates were tested for antimicrobial susceptibility to third-generation cephalosporins (Cefotaxime, Ceftazidime, and Ceftriaxone). The Combination Disk Technique (clavulanic acid+third-generation cephalosporins) was used to inoculate the bacterial isolates to demonstrate their capacity to create ESBL. In comparison to non-ESBL producers, the ESBL producers were assessed. Results: E. coli, Klebsiella, S. aureus, Proteus, and Pseudomonas were among the microorganisms isolated from UTI patients. 61% of the participants in this study were female, whereas 39% were male. E. coli has an increased frequency among isolated bacteria, as it presented in 46% of urine cultures, followed by pseudomonas and Klebsiella, each with a 22% frequency. Growth of the majority of the bacteria was found among females more frequently than males, and it also seems to be among older age patients than younger. Amoxyl alone and in combination with Clavulanic Acid (AAMC) was the most medicine that bacteria were resistant to (76%), but Ceftriaxone (CTR) has higher sensitivity (45%) and resistance (50%). The growth of the bacteria in the media of antibiotics was sorted into sensitive, intermediate, and resistant. Conclusions: Tested antibiotic resistance was higher for AAMC than for CTR, which is typically taken without performing urine sample culture and sensitivity testing, which over time leads to increased resistance.

MP53-19 URINARY MICRORNAS ARE POTENTIAL BIOMARKERS OF SEVERITY OF URINARY TRACT DYSFUNCTION IN PATIENTS WITH POSTERIOR URETHRAL VALVES

You have accessJournal of UrologyCME1 Apr 2023MP53-19 URINARY MICRORNAS ARE POTENTIAL BIOMARKERS OF SEVERITY OF URINARY TRACT DYSFUNCTION IN PATIENTS WITH POSTERIOR URETHRAL VALVES Elizabeth Mann, Melissa Mogle, Aditi Paranjpe, Marion Schulte, and Pramod Reddy Elizabeth MannElizabeth Mann More articles by this author , Melissa MogleMelissa Mogle More articles by this author , Aditi ParanjpeAditi Paranjpe More articles by this author , Marion SchulteMarion Schulte More articles by this author , and Pramod ReddyPramod Reddy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current management strategy for patients presenting with posterior urethral valves (PUV) includes monitoring of renal function to determine when urinary tract (UT) intervention such as intermittent catheterization or urinary diversion is indicated. The challenge with this approach is that ongoing renal injury may no longer be reversible and exposes the child to progression of chronic kidney disease (CKD). We hypothesize that microRNAs (miRNA) derived from urinary small extracellular vesicles (sEV) reflect the physiological status of the UT and may serve as real-time indicators of lower urinary tract injury. These biomarkers could permit the development of a proactive strategy of serial monitoring of the lower UT in patients with PUV and permit timely intervention prior to the progression of renal injury. METHODS: We have undertaken an IRB approved prospective study. Informed consent was obtained at time of enrollment. Urine samples are collected for each patient at least once a year and urinalysis performed. We excluded samples with active infections. Patients (1-18 yrs) with PUV were stratified into clinical categories based on the severity of the involvement of their UT. Patients with isolated genital pathology and a normal UT served as negative controls. sEVs were isolated from the urine by ultracentrifugation and total RNA extracted. Next-generation small RNA sequencing and differential expression analysis was performed. RT-qPCR was used to verify the expression of candidate miRNAs. RESULTS: A total of 76 PUV Patients and 35 controls have been enrolled in the study, with 244 urine samples collected. Principle component analysis of the most variable miRNAs demonstrated a clear clustering of the patients in the moderate/severe category compared to the patients with mild disease and non-PUV controls. We have identified 61 miRNAs that were upregulated and 45 miRNAs that were downregulated in the moderate/severe patients (≥1.5-fold, p≤0.05). We selected 4 miRNAs to analyze further by RT-qPCR and confirmed the decreased expression of miRNA-30a-5p in moderate/severe cases (>5-fold, p≤0.01). CONCLUSIONS: This study demonstrates that urinary miRNAs can serve as biomarkers of the severity of UT dysfunction in patients with PUV. Ongoing studies seek to further validate these findings. The development of a noninvasive urinary assay for a set of predictive miRNA biomarkers will enhance our ability to care for patients with PUV and enable real-time assessment of the health of their lower urinary tract. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e719 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Mann More articles by this author Melissa Mogle More articles by this author Aditi Paranjpe More articles by this author Marion Schulte More articles by this author Pramod Reddy More articles by this author Expand All Advertisement PDF downloadLoading ...

Determine the Ability of Bacterial Isolates from Urinary Tract Infections on L-Asparginase Production

This study was conducted to isolate and identify the pathogenic bacterial species from urinary tract of patients that reviewers to Tikrit hospital education from tow gender and different age periods. It was also the determination of bacterial species isolated in their ability to production of the L-asparginase enzyme and assay the environmental conditions and the production media ingredients for high concentration of enzyme production. Results showed that 142 samples was positive in microbial isolation (91.64%) from the total study samples that were at 150 samples, and high isolation percentage was from female at 58% and from aged period between 15 to 75 years for two gender. It also found that the species of bacterial E.coli was appear as highest in isolation percentage followed by Citrobacter diversus, Enterobacter aerogenes and Klebsiella pneumonia which was at 54.2, 21.1, 17.6 and 7.04% respectively. The assay of bacterial isolates to L-asparginase produce illustrate that the E.coli species appear as the most production and the isolate no. 3 was the top one at 70.4 IU/ml of media. When the assay of environmental conditions and ingredients combination for media to access for higher production from enzyme, shows that the optimal conditions for production of E.coli-Iso.3 was in development at 35 º c, pH 7.0 for 24 hours with agitation at 150 rpm in the media consists of maltose, L-asparginase, NaCl and KH2PO4 at 10, 100, and 5.0 and 0.75 g/l respectively.

Bacterial quality of urinary tract in patients with alkaptonuria

BackgroundThe aim of the current study was to determine whether there is an association between alkaptonuria (AKU) and urinary tract infection (UTI) by exploring the bacterial quality of the urinary tract, as most of the patients with AKU present with frequent occurrence of urinary tract symptoms such as incomplete emptying of urinary bladder, dysuria and nocturia. MethodsStudy samples were collected from 22 participants; 9 from patients with AKU, 9 from individuals who were AKU carriers, and 4 people served as control. Confirmation of AKU diagnosis was established by the ferric chloride test and quantitative determination of urinary homogentisic acid (HGA) levels. ResultsIn the ferric chloride test, the urine samples of AKU patients showed a characteristic black ring upon addition of few drops of ferric chloride solution. During urinary HGA determination, patients with AKU had increased levels of urinary HGA as compared to carriers and controls. The following 10 bacterial species were isolated from the urinary tract of AKU patients, carriers and controls: Sphingomonas paucimobilis, Escherichia coli, Francisella tularensis, Staphylococcus hominis, Staphylococcus haemolyticus, Leuconostoc mesenteroides, Dermacoccus nishinomiyaensis, Kytococcus sedentarius, Serratia fonticola and Granulicatella adiacens. The presence of S. paucimobilis was found in three male patients, and one female each from the carrier and control groups. Almost all study samples were positive for D. nishinomiyaensis and K. sedentarius. S. fonticola and G. adiacens were found only in AKU carrier females. ConclusionsThe results deduced that males show symptoms of arthritis early and more severely than females and by this it appears that there is an association between these symptoms and the percentage of bacterial infection in males that requires more accurate diagnosis and treatment to clarify such relationship. In the current study, males (patients, carriers, and controls) were more likely to have bacterial infections than females (64% vs. 36%). The 16 and 2 bacterial isolates, detected in 7 males and 2 females AKU patients, respectively, revealed that male AKU patients had a 2.3-fold greater rate of bacterial infection than female AKU patients. Therefore, further studies are warranted to investigate if there's any relationship between higher incidence of bacterial infections and development of AKU-related clinical symptoms in the male population.

Fesoterodine treatment of pediatric patients with neurogenic detrusor overactivity: A 24-week, randomized, open-label, phase 3 study

Neurogenic detrusor overactivity (NDO) can damage the upper urinary tract leading to chronic renal impairment. Antimuscarinic therapy is used to improve urinary incontinence and protect the upper urinary tract in patients with NDO. This study investigated safety and efficacy of fesoterodine, a muscarinic receptor antagonist, in 6‒<18-year-old patients with NDO (NCT01557244). This open-label phase 3 study included 2 pediatric cohorts. Patients in Cohort 1 (bodyweight >25kg) were randomized to fesoterodine 4 or 8mg extended-release tablets or oxybutynin XL tablets administered over the 12-week active comparator-controlled phase. The safety extension phase evaluated fesoterodine 4 and 8mg for a further 12 weeks, with patients in the oxybutynin arm allocated to fesoterodine 4 or 8mg. Patients in Cohort 2 (bodyweight ≤25kg) were randomized to fesoterodine 2 or 4mg extended-release beads-in-capsule (BIC) administered over a 12-week efficacy phase and 12-week safety extension phase. Patients with stable neurologic disease and clinically or urodynamically proven NDO were included. The primary endpoint was change from baseline to Week 12 in maximum cystometric bladder capacity (MCC). Secondary efficacy endpoints included detrusor pressure at maximum bladder capacity, bladder volume at first involuntary detrusor contraction, bladder compliance, and incontinence episodes. Safety endpoints included adverse event incidence, and specific assessments of cognition, behavior and vision. The pharmacokinetics of 5-hydroxymethyl tolterodine (5-HMT; fesoterodine's active metabolite) was determined using population-pharmacokinetic analysis. In Cohort 1 (n=124), fesoterodine 4 and 8mg treatment resulted in significant increases from baseline in the primary endpoint of MCC at Week 12. In Cohort 2 (n=57), fesoterodine 2 and 4mg BIC treatment resulted in improvements in MCC from baseline. Fesoterodine 4 and 8mg and fesoterodine 4mg BIC led to improvements in some secondary efficacy endpoints. The most common treatment-related adverse reactions were gastrointestinal effects, such as dry mouth, which occurred more frequently with oxybutynin than fesoterodine. No detrimental effects on visual accommodation or acuity, or on cognitive function or behavior were observed. These safety and efficacy results are consistent with limited published data on fesoterodine treatment in pediatric populations with overactive bladder or NDO. Study limitations include the lack of placebo control and the small sample size, which limits the ability to make formal efficacy comparisons and detect rare adverse reactions. Fesoterodine has a favorable benefit-risk profile in 6‒<18-year-old patients with NDO and may represent an additional option for pediatric NDO treatment.

Lower pole obstructive megaureter of duplex kidney: an exception to the Weigert-Meyer rule

Introduction. Anatomical features of the urinary tract in patients with duplicate kidneys are described using the Weigert-Meyer rule, since the orifice of the upper ureter has an ectopic location (inferomedial) and the orifice of the lower ureter has an orthotopic location (superolateral). However, there are rare cases of violation of this rule, complicated by obstructive megaureter, ectopic ureteral orifice, the presence of ureterocele.Objective. To report the rare clinical case of a lower pole obstructive megaureter as a violation of the Meyer-Weigert rule in the patient with complete ureteral duplication and to describe the use of ureteroureterostomy as an effective and safe method of surgical correction of the presented anomaly.Clinical case. We present a case of the infant (5 months old) with a lower pole obstructive megaureter. This pathology was identified through intravenous urography and voiding cystourethrography. Laparoscopic proximal end-to-side ureteroureteroanastomosis was chosen as a surgical treatment. Postoperative control intravenous urography showed the effectiveness (a reduction in the lower pole collecting system of the duplex kidney was revealed) and the safety of this method of correction.Conclusion. There are only several clinical cases about exceptions to the Weigert-Meyer rule reported in literature, and most of them are about adult patients. The main surgical method of treatment in such cases is heminephrectomy. To our knowledge, this is the only reported case of using ureteroureterostomy in the patient with a lower pole obstructive megaureter. This technique has shown its effectiveness and safety for restoring the patency of the urinary tract, confirmed during the control postoperative examination.

Application of urodynamics combined with contrast-enhanced ultrasound in evaluation of the urinary tract in patients with low bladder compliance and vesicoureteric reflux who underwent bladder augmentation alone.

We assessed the use of common urodynamics (CUD) combined with contrast-enhanced ultrasound (CEUS) to investigate the efficacy and durability of sigmoid cystoplasty alone in patients with low bladder compliance associated with vesicoureteric reflux (VUR). In this study, we recruited 25 patients with low bladder compliance and VUR who underwent bladder augmentation without antireflux surgery at our institutions between June 2017 and June 2021. The bladder condition and VUR grade were assessed preoperatively and postoperatively via CUD combined with CEUS. The mean follow-up period was 2.6 years. CUD showed significant improvement in bladder capacity and compliance and a decrease in intravesical pressure after sigmoid cystoplasty. CEUS demonstrated resolution of VUR compared with preoperative assessment. Of the 25 patients who had various degrees of reflux, VUR was eliminated in 18 patients and reduced to a lower grade in the remaining seven patients. CUD combined with CEUS is accurate and safe. They are invaluable and reliable tools for morphological and functional evaluations of the entire urinary tract in patients with low bladder compliance and VUR.

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

Peculiarities of Restoration of the Functional Condition of the Kidney Parenchyma in Children with Congenital Defects of the Ureterovesical Segment Depending on Methods of Its Operative Correction (According to Cytokine-enzymological Criteria)

Peculiarities of Restoration of the Functional Condition of the Kidney Parenchyma in Children with Congenital Defects of the Ureterovesical Segment Depending on Methods of Its Operative Correction (According to Cytokine-enzymological Criteria)

Fungal Urinary Tract Infection; A Study Conducted On Patients With Liver Cirrhosis

Objective: To determine frequency of fungal infection of urinary tract in patients with liver cirrhosis Design &amp; duration: This is a cross sectional study. This study was completed in duration of six months. Setting: Study was conducted in Margalla Hospital Gulshan Colony PMO, Taxila. Patients &amp; Methods: Patients admitted in study hospital with liver cirrhosis having child class A, B and C were evaluated for fungal urinary tract infection, belonging to any gender, having age above 40 years. All data was documented and analyzed using SPSS software version-20 and means, frequencies, standard deviation and p-value were calculated. Results presented in the form of tables and graphs. Results: Total 400 cases were evaluated for fungal urinary tract infection having liver cirrhosis admitted in study hospital in given duration of study. Fungal cause of UTI was found in 260 cases including 29.3% male and 70.7% female cases. While other causes were found in 140 cases. According to child classification out of 260 cases with fungal UTI, 11 cases were in class B and 249 cases were in class-C while no case belonged to class-A. Most of the cases (42%) with UTI were in age interval of 40-50 years. Duration of CLD was 2-4 years in most of the cases (30%). Conclusion: Fungal cause of urinary tract infection is very common among patients with liver cirrhosis and older age as these cases have week immunity Key words: Liver cirrhosis, chronic liver disease, urinary tract infection, fungal infection, immunocompromised

Optimizing the lithotripsy timing after drainage of the upper urinary tract in patients with urolithiasis and obstructive uropathy

Introduction. Timely unresolved upper urinary tract (UUT) obstruction in patients with infection can cause severe complications, such as sepsis, pyonephrosis and even death. There are no clear recommendations regarding the methods and timing of drainage. At the same time, this issue is still the subject of discussion in publications of recent years.Purpose of the study. To optimize the timing of lithotripsy after drainage of the UUT in patients with urolithiasis and obstructive uropathy (OU).Materials and methods. At the first stage, 90 patients with OU caused by the stone of the ureteropelvic junction underwent drainage of the UUT using a percutaneous nephrostomy. Subsequently, percutaneous nephrolithotripsy (PNLT) was performed at various times after drainage. The level of inflammatory markers (IL-8) and profibrotic factor (MCP-1) in the urine was determined. The calculated concentrations of urinary biomarkers were normalized by the level of urinary creatinine. Urine sampling for the analysis was carried out during and after the PCN placement (nephrostomy urine) 7 days later, and then once weekly before surgery. The coefficient K was calculated using a patented formula to evaluate the process of kidney remodeling. Urine sampling was performed for culture to determine the bacterial spectrum and antibiotic sensitivity.Results. The values of K ≤ 1.85 were observed in 11 patients of the group with OU (12.2%), K &gt; 1.85 in 79 (87.8%) by day 21. The values of K ≤ 1.85 were achieved in 70 patients (88.6%) by day 28 and 4 patients (80.0%) by day 35. PNLT was performed on 21 days in patients with K ≤ 1.85 (11 patients), no complications were noted in the postoperative period., PNLT was performed in patients with K ≤ 1.85 (70 patients) by day 28, exacerbation of pyelonephritis and the development of chronic kidney disease were not noted. Six patients with values of K ˃ 1.85 underwent PNLT by day 28. In the postoperative period, all patients had an exacerbation of calculous pyelonephritis, 50% had a decrease in glomerular filtration rate within 3 months after surgery. The bacteria in urine were detected in 55 (61.0%) patients. Escherichia coli (63.0%), Proteus mirabilis (18.0%), Enterococcus faecalis (14.5%), Streptococcus haemolyticus (2.5%) were identified most often.Conclusion. The use of the developed remodeling index allows optimizing the surgery timing and minimizing the development of complications during the postoperative period. The presence of bacteria is associated with a long process of renal parenchymal remodeling.