Urinary Tract Symptoms Research Articles

The relationship between overactive bladder and prostate cancer: A scoping review.

The relationship between prostate cancer (PCa) and overactive bladder (OAB) is poorly understood. PCa and OAB are frequently diagnosed in elderly populations, so it could be expected that both conditions would be observed in older patients. Whether PCa and OAB occur independently with age, or the presence of PCa leads to the onset of OAB/lower urinary tract symptoms (LUTS) has not been explored. This review aimed to investigate whether men newly diagnosed with PCa are more likely to have OAB compared to the general population, and if the various treatment modalities for PCa are likely to impact the incidence or exacerbation of OAB. The University of Calgary's databases for Medline and PubMed were searched for relevant publications. No restrictions were placed on the study design reported. Any publications reporting OAB and a PCa diagnosis and/or observation relating to PCa diagnosis and rates of OAB/LUTS in an adult population were included for full review. Of the studies examining the relationship between PCa and LUTS, results varied, but frequently indicated an inverse association between PCa and LUTS in which patients newly diagnosed with PCa were more unlikely to have LUTS compared to the general population. Following treatment, brachytherapy resulted in a higher prevalence of OAB symptoms compared to surgical treatment and external beam radiation therapy. Diverse evidence was found regarding the relationship between the prevalence of pre-treatment OAB and PCa diagnosis. However, limited evidence, as well as uncertainty regarding pre-treatment symptoms and their impact on post-treatment outcomes, restricts potential conclusions.

Pre- and postmenopausal women have different core urinary microbiota

Recent studies suggest that alterations in the female urinary microbiota is associated to development of bladder disease. However, the normal microbiota composition and variation in healthy women are poorly described. Moreover, the effects of hormonal changes on microbiota during menopause is not well understood. The aim of our study was to investigate the urinary microbiota in healthy pre- and postmenopausal women without urinary tract symptoms. Microbiota composition in catheterized urine samples was mapped using 16S rRNA gene sequencing. In total, 41 premenopausal and 42 postmenopausal women were initially included. Samples with first PCR amplification concentration below level of the negative control were excluded, resulting in 34 premenopausal and 20 postmenopausal women included in data analysis. Urine from postmenopausal women showed significantly higher alpha diversity compared to premenopausal women. Lactobacillus was the most abundant bacteria in both groups, however the relative abundance of Lactobacillus accounted for 77.8% in premenopausal versus 42.0% in postmenopausal women. In conclusion, urine from premenopausal mostly presented with Lactobacillus dominated urotypes, whereas urine from postmenopausal women presented a more diverse urinary microbiota with higher abundance of the genera Gardnerella and Prevotella. The clinical and pathophysiological implications of this difference remain to be elucidated.

Changes in the expression and functional activities of Myosin II isoforms in human hyperplastic prostate

Benign prostatic hyperplasia (BPH) is a common disease among aging males with the etiology remaining unclear. We recently found myosin II was abundantly expressed in rat and cultured human prostate cells with permissive roles in the dynamic and static components. This study aimed to explore the expression and functional activities of myosin II isoforms including smooth muscle myosin II (SMM II) and non-muscle myosin (NMM II) in the hyperplastic prostate. Human prostate cell lines and tissues from normal human and BPH patients were used. H&E, Masson's trichrome, immunohistochemical staining, in vitro organ bath, RT-PCR and Western-blotting were performed. We further created cell models with NMM II isoforms silenced and proliferation, cycle, and apoptosis of prostate cells were determined by CCK-8 assay and flow cytometry. Hyperplastic prostate SM expressed more SM1 and LC17b isoforms compared to their alternatively spliced counterparts, favoring a slower more tonic-type contraction and greater force generation. For BPH group, blebbistatin (BLEB, a selective myosin II inhibitor), exhibited a stronger effect on relaxing phenylephrine (PE) pre-contracted prostate strips and inhibiting PE induced contraction. Additionally, NMMHC-A and NMMHC-B were upregulated in hyperplastic prostate with no change in NMMHC-C. Knockdown of NMMHC-A or NMMHC-B inhibited prostate cell proliferation and induced apoptosis, with no changes in cell cycle. Our novel data demonstrates that expression and functional activities of myosin II isoforms are altered in human hyperplastic prostate, suggesting a new pathological mechanism for BPH. Thus, the myosin II system may provide potential new therapeutic targets for BPH/lower urinary tract symptoms (LUTS).

What brings adolescents to the Obstetrics and Gynaecology Emergency Department of a General Hospital

Introduction: Paediatric & Adolescent Gynaecology is a special field and also part of the everyday practice. This paper studies the problems adolescent females present with at the Obstetrics & Gynaecology (O&G) Emergency Department (ED). Material and Methods: Data regarding adolescent females that were examined at the O&G ED over one year (2018) were extracted from the records of Konstantiopouleio General Hospital, Athens, Greece. Results: Of the 1534 women that attended O&G ED over one year, 111 were under 19 years old (7%). Of the 83 gynaecological cases, the presenting symptom was pelvic pain in 54 (65%), irregular vaginal bleeding in 11(13%), urinary tract symptoms in 11(13%), vaginal discomfort in 3 (4%) and others in 4 (5%). In 39 (47%) no urgent gynaecological pathology was detected. There were 11 cases (13%) of ovarian cysts, 10 of urinary tract infection (12%), 7 (8%) of other surgical pathology, 6 (8%) of first trimester pregnancy complications and 10 others. Of the 28 pregnant adolescents, 10 complained of abdominal pain (36%), 6 of hyperemesis (21%), 5 of myometrial activity (18%), 4 of vaginal bleeding (14%). In 18 cases (64%) no acute medical condition was diagnosed, 4 were admitted in active labour (14%) and one with threatened delivery, two were referred to other specialties and three refused the examination. Conclusion: O&G emergency conditions in adolescent females are common and potentially serious. Healthcare professionals need to be aware and alert to the special needs of this significant and sensitive population group.

Female nurses have a higher prevalence of urinary tract symptoms and infection than other occupations in dialysis units.

Introduction:Urinary tract symptoms and infection have been associated with occupational factors that impact hydration habits particularly in women. We compared self-reported urinary symptoms and infection and hydration habits between nurses and other occupations in dialysis units.Methods:Cross-sectional study. Participants worked in five nephrology centers in Brazil and answered an online questionnaire comprising questions regarding urinary tract symptoms and infection episodes in the preceding year; data on usual daily beverage intake, urine frequency, and urine color according to a urine color chart were also collected, as well as perceptions of water access and toilet adequacy at work.Results:We included 133 women (age=36.9±9.5 years). The self-reported usual daily beverage intake was 6.6±2.9 cups/day (~1320 mL), daily urine frequency was 5.4±2.1, and urine color chart score: 3.0±1.2. Nurses (N=66/49.6%) reported higher prevalence of burning sensation (50 versus 27%; P<0.001), urinary urgency (42 versus 21%; P<0.001), and infection (42% versus 25%; P=0.04) as well as lower liquid intake (6.0±2.6 versus 7.3±3.0 cups/day; P=0.01) than controls. Forty four percent of nurses reported being able to drink when thirsty "always" and "most of the time" versus 93% of the control group.Conclusion:Dialysis female nurses reported lower beverage intake and higher prevalence of symptoms and infection than other occupations in the same environment. Interventions to improve hydration can potentially decrease urinary problems in this population.

Comparison of Imaging Characteristics on Computed Tomography and Magnetic Resonance Urography in Urological Conditions

Introduction: Urinary tract (UT) pathologies are common causes of morbidity presenting mainly as acute flank pain, obstructive uropathy, and hematuria with calculus being the commonest cause. Computed tomography (CT) (noncontrast, contrast enhanced and urography) of the kidney, ureter, and bladder region has been considered as the mainstay in evaluation of patients with UT symptoms. Limitations of radiation exposure and risks of contrast injection in CT have provided space for magnetic resonance urography (MRU) that has recently gain acceptance. However, MRU is limited by its availability and higher cost. Thus, with the aim of evaluating the scope of MRU in various UT pathologies, we planned a comparative study between CT scan and MRU. Materials and Methods: Thirty-five patients with UT symptoms (acute flank pain, obstructive uropathy, and hematuria) were evaluated with CT scan and MRU after obtaining approval from Institutional Ethics Committee and written informed consent from the participants of the study. CT scan was performed on 128-slice CT scanner while MRU was performed on 1.5T magnetic resonance scanner using the standard protocol. The data thus recorded in a single-blinded manner were analyzed using appropriate statistical methods and tools. Results: Compared with CT scan, MRU had a poor accuracy in detecting UT stones especially &lt;6 mm and without secondary signs of obstruction. However, MRU performed very well in patients with obstructive uropathy and hematuria subgroup with no significant difference in accuracy from CT scan. Overall, MRU had a moderate sensitivity of 76.3%, high specificity of 96.9% and moderately high accuracy of 85.7%. Conclusions: Although MRU has lower sensitivity to small sized UT calculus but is very specific to secondary signs of obstruction as well as to causes of obstructive uropathy and hematuria. It can serve as an excellent alternative tool especially in patients with contraindication of contrast injection in CT scan as well as in children, during pregnancy and in conditions requiring repetitive examinations.

A variant of Zinner syndrome presenting with terminal hematuria: A case report

Introduction. Zinner syndrome is a rare congenital malformation characterized by ipsilateral renal agenesis or hypoplasia, seminal vesicle cysts, and ejaculatory duct obstruction. Patients are usually asymptomatic or develop unspecific symptoms. Case Report. We present a case of a 22-year-old male patient who presented with painless terminal hematuria. The patient denied trauma or other urinary tract symptoms. Magnetic resonance imaging of the abdomen and pelvis revealed a right renal hypoplasia, a tortuous dilated right ureter draining into polycystic right seminal vesicle, and a dilated ejaculatory duct. Conclusion. The size of the seminal vesicle cyst and symptoms affect the treatment. Asymptomatic cysts may be treated conservatively, while cysts that cause symptoms are often an indication for surgical treatment, due to the possibility of infertility caused by the obstruction of the ejaculatory canal. Magnetic resonance imaging has high-resolution properties providing excellent presentation of anatomical relationships and pathology which is extremely important in case of the need for surgical treatment.

Multilocular cystic renal neoplasm of low malignant potential: Mimicker of cystic clear cell carcinoma – urologist’s perspective

Introduction Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) is a rare subtype of clear cell renal cell carcinoma (ccRCC) accounting for 2-4% of RCC. It is defined as a neoplasm that is composed entirely of numerous cysts surrounded by fibrous capsule and septa containing clear cells without expansile growth or mural nodules (WHO 2016). The purpose of this manuscript is to highlight that it is imperative to identify this entity by strict histological criteria and distinguish this entity from cystic ccRCC due to its low malignant potential, excellent prognosis with no recurrence or metastasis. Case report A 46-year-old male presented with continuous mild loin pain for a month. There were no lower tract urinary symptoms. Ultrasound abdomen showed left lower pole renal mass. CECT-KUB was done as a definitive investigation which showed a solitary left lower pole renal cystic lesion with enhancement of size 3.8x3.6cm (Bosniak IV). As per CT findings, the patient underwent Laparoscopic partial nephrectomy. Histopathological examination showed multiple cysts with thin septal walls possessing clear cells with low-grade nuclei. 2 years of follow-up postoperatively with imaging studies revealed no recurrence or metastasis. Conclusions The purpose of this report is to emphasize the need to identify this entity by strict histological criteria as per WHO guidelines, as imaging studies were more often inconclusive. Urologists should have an adequate understanding such an entity. Almost all cases are amenable to partial nephrectomy irrespective of size and no documented evidence of recurrence and metastasis which mandates less stringent follow up postoperatively as compared to ccRCC.

Experience in the use of MOSES technology for endoscopic treatment of benign prostatic hyperplasia

Introduction. The development of laser technologies in medicine and their introduction into everyday clinical practice determine the trend of using this type of energy in the treatment of patients with lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH). In the last decade, holmium laser enucleation (HoLEP) of the prostate has been claiming to be «the gold standard» in the BPH treatment. The advantages of HoLEP over alternative technologies (transurethral resection, bipolar enucleation) in the BPH treatment have been demonstrated in randomized trials. These advantages include the reduction of the patient's hospital stay, safety of manipulation and high quality of life for the patient after surgery. The use of electrical energy in resection techniques for the BPH treatment in most cases is limited by the prostate volume (80 cm3). A better understanding of the effect of laser radiation and its clinical efficacy has led to increased interest and widespread adoption of laser systems. The constant search and improvement of existing approaches encourages urologists and surgical equipment companies to research new laser systems. One type of improvement is a software update for laser pulse modulation that has been developed to improve the efficiency of laser equipment. For the further development of new laser technologies and widespread use in routine clinical practice, it is necessary to compare them with standard methods of BPH surgical treatment with an assessment of the effectiveness, as well as the pros and cons of the compared methods.Purpose of the study. To evaluate the results of laser endoscopic treatment of patients with prostatic hyperplasia.Materials and methods. The study included 50 patients with prostatic hyperplasia who underwent two different types of surgery — HoLEP (group I; n = 25) and HoLEP with MOSES (HoLEP-M) technology (group II; n = 25). Inclusion criteria were: the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume &gt; 40 cm3, maximum urine flow (Q-max) &lt; 12 ml/sec. Exclusion criteria were: the presence of cystostomy drainage, an oncological process of the urinary system, an active inflammatory process of the genitourinary system, previous surgical interventions on the urinary system. I-PSS, QoL and IIEF questionnaires data, the level of prostate-specific antigen (PSA), the maximum flow of the urine stream (Q-max) and the post-void residual volume were assessed at baseline and 3 months after the operation. The main indicators of the compared methods, the number and nature of complications were studied.Results. Both methods of laser enucleation allow achieving a good functional result with a minimum number of complications. When comparing both methods in the group II of patients who underwent HoLEP-M, there was a statistically significant difference in terms of characteristics: the time of enucleation in group I (HoLEP) — 46.7 ± 15.0 min (31 - 80) vs group II (HoLEP-M) — 38.9 ± 7.6 min (30 - 60) (p = 0.03), but this did not affect the total time of surgery (p = 0.21), the level of haemoglobin postoperative changes in group I (HoLEP) — 7.5 ± 5.4 g/l (2 - 18) vs group II (HoLEP-M) — 5.0 ± 2.9 g/l (2 - 13) (p = 0.04) and irrigation time in the postoperative period, group I (HoLEP) — 17.6 ± 3.6 h (11 - 26) vs group II — 14.0 ± 4.3 h (5 - 21) (p &lt; 0.001). Thus, the results of the study suggest that the HoLEP with the modified pulse MOSES technology has advantages over the standard HoLEP technique. HoLEP-M allows you to perform the enucleation stage faster, with better hemostasis and minimizes the effect of the laser on the surrounding tissues. Complications above level 2 were not observed in both groups according to the Clavien-Dindo scale.Conclusion. HOLEP-M is a safe method of surgical treatment of prostatic hyperplasia from the point of view of surgical safety, efficacy, as well as the duration of the patient's recovery period and can serve as an alternative to the HoLEP standard technique.

Comparative evaluation of clinical efficacy, safety, and economic expenses of two endoscopic techniques for treating prostatic hyperplasia in elderly patients

Introduction. Rapidly developing highly specialized medical care and the emergence of new medical technologies determine the trend in surgical, minimally invasive treatment of patients with lower urinary tract symptoms due to prostatic hyperplasia. Drug therapy in elderly patients with somatic diseases poses a problem of poor compliance due to pronounced side effects caused by a drug. In this group of patients, surgical treatment of prostate hyperplasia is the most preferred solution. A doctors task is to choose the optimal method of surgery which will not only provide a long-term clinical effect, but also will minimize the economic costs of both surgical intervention and the postoperative period. The emergence of various types of energies for enucleating the prostate gland in urological practice has become an attractive alternative to transurethral resection of the prostate (TURP). However, when choosing surgical endoscopic intervention, it is important to consider the economic factor, which is considered to be a crucial problem in the medical care in Russia. Modern treatment options can not only prevent serious complications, and additional surgical interventions, but also improve the quality of patients lives. However, the introduction of new technologies is impossible without taking into account data on their cost-effectiveness.&#x0D; Purpose. To compare the results and evaluate cost-effectiveness of two types of BPH endoscopic surgical treatment (bTURP, HOLEP) in elderly patients (60 years old).&#x0D; Materials and methods. The study includes patients who underwent two different methods of endoscopic treatment of HPV (bTURP, HOLEP) from October 2017 to September 2018. The inclusion criteria were the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume 40 cm3, maximum urine flow 15 ml/sec. The exclusion criteria were the presence of cystostomy drainage, oncological process of the urinary system, active inflammatory process of the genitourinary system, previous surgical interventions on the organs of the urinary system, and symptoms of an overactive bladder. In each group of the patients the following indicators were evaluated the international system for the total assessment of prostate diseases (IPSS and QoL), the international index of erectile function, the dynamics of postoperative changes in prostate-specific antigen, the maximum urine flow, the residual volume, safety of the operation, intraoperative and postoperative economic expenses as well as socio-economic consequences. Cost-effectiveness analysis was carried out by calculating the indicators cost-effectiveness, cost-utility, net monetary benefit. 20-year prediction of the results was carried out by building the Markov chain model.&#x0D; Results. 150 patients operated within a year were examined. HOLEP has showed its clinical efficacy before bTURP in terms of the duration of surgery, the volume of tissue removed, the time of postoperative catheterization and the length of hospital stay which was significantly lower in the HOLEP group. However, the economic expenses associated with HOLEP were also higher compared to the bTURP group.&#x0D; Conclusions. Holmium laser enucleation is the preferred method for surgical treatment of prostatic hyperplasia in the prostate of more than 40 cm3, from the point of view of surgical safety, effectiveness, and also the length of the patients recovery period in elderly patients. Moreover, laser operations are considered to be economically reasonable in comorbid patients associated with a minimal risk of complications.

Urogenital System Damaging Manifestations of 3 Human Infected Coronaviruses.

At present, there are no comparative studies on the damage of the 3 coronaviruses infections to the urinary system. Therefore, we reviewed the correlations and differences between invading mechanisms and resultant urogenital system damage by the 3 kinds of coronaviruses in an effort to help doctors in the prevention and treatment of these damages, which will be of significance in improving prognosis and quality of life after rehabilitation. We searched PubMed® for English language articles published since 2003 with the key words "Coronavirus disease 2019 (COVID-19)," "severe acute respiratory syndrome-2 (SARS-CoV-2)," "severe acute respiratory syndrome (SARS)-CoV" and "Middle East respiratory syndrome (MERS)-CoV "with "semen" and "kidney." We also used relevant data from websites including the World Health Organization and Centers for Disease Control and Prevention. Recent studies have revealed that both SARS-CoV and SARS-CoV-2 invade target cells through a membrane-bound angiotensin-converting enzyme 2, an important component of the renin-angiotensin system, which maintains human homeostasis, whereas MERS utilizes host cells' receptor dipeptidyl peptidase 4 for entry. While pneumonia is the most prominent symptom in patients infected by coronaviruses due to the transmission through respiratory droplets, the urogenital system can also suffer from infection with coronaviruses, resulting in renal failure, testicular atrophy etc. The impairments of the genitourinary system would be different with the 3 coronavirus infections but they still have a strong correlation. The pathogenesis and clinical symptoms of SARS-CoV, MERS-CoV and SARS-CoV-2 coronaviruses in the genitourinary system are comparable. All 3 coronaviruses have been found to affect kidney and testicular function. Therefore, both urologists and nephrologists should pay attention to the damage caused by coronavirus infection to the genitourinary system, especially monitoring renal and semen function.

Changes in the expression and function of the PDE5 pathway in the obstructed urinary bladder.

Our study aims to explore changes in bladder contractility and the phosphodiesterase type 5 (PDE5) signalling pathway in response to partial bladder outlet obstruction (PBOO). A surgically induced male rat PBOO model and human obstructed bladder tissues were used. Histological changes were examined by H&E and Masson's trichrome staining. Bladder strip contractility was measured via organ bath. The expressions of nitric oxide synthase (NOS) isoforms, PDE5, muscarinic cholinergic receptor (CHRM) isoforms and PDE4 isoforms in bladder were detected by RT‐PCR and Western blotting. The immunolocalization of the PDE5 protein and its functional activity were also determined. PBOO bladder tissue exhibited significant SM hypertrophy and elevated responsiveness to KCl depolarization and the muscarinic receptor agonist carbachol. NOS isoforms, PDE5, CHRM2, CHRM3 and PDE4A were up‐regulated in obstructed bladder tissue, whereas no change in PDE4B and PDE4D isoform expression was observed. With regard to PDE5, it was expressed in the SM bundles of bladder. Interestingly, obstructed bladder exhibited less relaxation responsiveness to sodium nitroprusside (SNP), but an exaggerated PDE5 inhibition effect. The up‐regulation of PDE5 could contribute to the lack of effect on Qmax for benign prostatic hyperplasia/lower urinary tract symptom (BPH/LUTS) patients treated with PDE5 inhibitors. Moreover, PDE5 (with presence of NO) and PDE4 may serve as new therapeutic targets for bladder diseases such as BPH‐induced LUTS and overactive bladder (OAB).

Mimicking prophage induction in the body: induction in the lab with pH gradients.

The majority of bacteria within the human body are lysogens, often harboring multiple bacteriophage sequences (prophages) within their genomes. While several different types of environmental stresses can trigger or induce prophages to enter into the lytic cycle, they have yet to be fully explored and understood in the human microbiota. In the laboratory, the most common induction method is the DNA damaging chemical Mitomycin C. Although pH has been listed in the literature as an induction method, it is not widely used. Here, we detail a protocol for prophage induction by culture under different pH conditions. We explored the effects of pH on prophage induction in bacterial isolates from the bladder, where the pH is well documented to vary significantly between individuals as well as between healthy individuals and individuals with urinary tract symptoms or disease. Using this protocol, we successfully induced phages from seven bladder E. coli strains. Testing conditions and stressors appropriate to the environment from which a lysogen is isolated may provide insight into community dynamics of the human microbiota.

Organic Diet and Intermittent Fasting are Associated With Improved Erectile Function

ObjectiveTo explore associations between dietary habits and erectile dysfunction (ED) in a cohort of patients presenting to a high-volume men's health clinic. Materials and MethodsAll patients presenting to a high-volume men's health clinic between July 2018 and May 2019 were evaluated for their dietary habits and screened with the International Index of Erectile Function-5 (IIEF-5) and Androgen Deficiency in Aging Males (ADAM). The primary outcome measure was the impact of dietary habits on ED, defined as IIEF-5 <22. Stepwise logistic regressions were used to control for patient characteristics and relevant comorbidities. ResultsTwo hundred seventy-one patients were included. Primary reasons for visit were ED (110, 40.6%), hypogonadism (39, 14.4%), benign prostatic hyperplasia/lower urinary tract symptoms (80, 29.5%), and Peyronie's Disease (30, 11.1%). 176 (64.9%) followed no diet, while 11 (4.1%), 11 (4.1%), 8 (2.9%), and 11 (4.1%) were whole food only, low-carb/keto, vegetarian/pescatarian, and low-fat, respectively. Additionally, 105 (38.7%) reported organic foods consumption, while 51 (18.8%) had no processed food consumption, and 77 (28.4%) performed intermittent fasting. Patients reporting ED were more likely to be over the age of 65, had higher body mass index, more comorbidities, and less likely to report an organic diet or intermittent fasting. There were no correlations between diet and ADAM score. In adjusted analysis, patients reporting organic diet or intermittent fasting were significantly less likely to have ED. ConclusionThis is the first study suggesting organic diet and intermittent fasting to be protective against ED. These results are hypothesis-generating and warrant further exploration.

On Yıldan Uzun Süre Üreteral J Stentle Yaşamanın Sonuçları

Amaç: Unutulmuş üreteral stentlerin infeksiyon, enkrustasyon, taşlaşma ve böbrek yetmezliği gibi majör komplikasyonları vardır. Bu komplikasyonlar stentin kalış süresi ile artar. Bu çalışmada 10 yıldan uzun süre üreteral stentle yaşayan hastaların tedavi yönetimi ve stentlerin hastalara verdiği zararlar tartışılmıştır.

Characteristics and Outcomes of Staphylococcus aureus Bloodstream Infection Originating From the Urinary Tract: A Multicenter Cohort Study.

Background Staphylococcus aureus bloodstream infection (SABSI) arising from a urinary tract source (UTS) is poorly understood.MethodsWe conducted a retrospective analysis in 3 major teaching hospitals in Spain of prospectively collected data of hospitalized patients with SABSI. SABSI-UTS was diagnosed in patients with urinary tract symptoms and/or signs, no evidence of an extra-urinary source of infection, and a urinary S. aureus count of ≥105 cfu/mL. Susceptibility of S. aureus strains and patient mortality were compared between SABSI from UTS (SABSI-UTS) and other sources (SABSI-other).ResultsOf 4181 episodes of SABSI, we identified 132 (3.16%) cases of SABSI-UTS that occurred predominantly in patients who were male, had high Charlson comorbidity scores, were dependent for daily life activities, and who had undergone urinary catheterization and/or urinary manipulation before the infection. SABSI-UTS was more often caused by MRSA strains compared with SABSI-other (40.9% vs 17.5%; P < .001). Patients with SABSI-UTS caused by MRSA more often received inadequate empirical treatment compared with those caused by susceptible strains (59.7% vs 23.1%; P < .001). The 30-day case fatality rate was lower in patients with SABSI-UTS than in those with SABSI-other (14.4% vs 23.8%; P = .02). Factors independently associated with mortality were dependence for daily activities (aOR, 3.877; 95% CI, 1.08–13.8; P = .037) and persistent bacteremia (aOR, 7.88; 95% CI, 1.57–39.46; P = .012).ConclusionsSABSI-UTS occurs predominantly in patients with severe underlying conditions and in those who have undergone urinary tract manipulation. Moreover, it is frequently due to MRSA strains and causes significant mortality.

P0243WOMEN WORKERS THAT DO NOT HAVE A WATER BOTTLE AT THE WORKPLACE HAVE HIGHER PREVALENCE OF URINARY TRACT SYMPTOMS AND INFECTION

Abstract Background and Aims Hydration and toilet behavior at work are associated with urinary tract symptoms (UTs) and infection (UTI) in women. We aimed to evaluate the association between self-reported hydration habits, water access and toilet adequacy at work with UTs and UTI in female workers from five dialysis clinics in Southern Brazil. Method All women employed were invited (n=258), and 69.4% (n=179) agreed to participate. For this analysis, we included female workers employed for at least 12 months who were not pregnant or breastfeeding in the last year. Weekly work shift varied from 30 to 42 hours, divided into five or six weekdays. Participants answered an online questionnaire comprising questions regarding UTs (burning feeling; frequent or intense urge to urinate; bloody urine; lower abdomen pain) and UTI episodes in the last year; usual daily beverage intake, usual urine frequency and color according to urine color chart; water access and toilet adequacy perception at work. Workers were divided into two groups according to the employee permission in having a water bottle (WB) at the workplace. Administrative and multidisciplinary staff are allowed (WB group) and nurse staff can not have (non-WB group) due to infection control regulation in dialysis rooms. Results We included 133 women (age=36.9±9.5 years old). Self-reported usual daily beverage intake= 6.6±2.9 cups/day (∼1320 ml); daily urine frequency= 5.1±2.1; urine color chart score= 3.0±1.2. At least one UTs was reported by 53% (n=70) and UTI episode by 34% (n=45) in the last year. Participants with UTs had a lower urine frequency (4.7±2.3 versus 5.5±1.7 times/day; P=0.03) and a higher urine color score (3.3±1.2 versus 2.6±1.1;P=0.002). Non-WB workers (N=66/49.6%) reported a lower beverage intake (6.0±2.6 versus 7.3±3.0 cups/day;P=0.01), had a higher prevalence of UTs (65% versus 45%; P=0.02) and UTI (42% versus 25%; P=0.04). Among non-WB participants, 47% considered that the distance to water supply from the workplace spot impairs adequate hydration, and 39% answered that the number of toilets available also as a barrier. A higher prevalence of UTs was reported by these subgroups that perceived environment infrastructure barriers (77% versus 54%; P=0.04 and 92% versus 47%; P&amp;lt;0.001, respectively). Non-WB who responded that toilet hygiene impairs hydration (11%) had a higher prevalence of UTI (86% versus 37%; P=0.03). No significant association between work environment perception and urinary problems was found in the WB group. Conclusion Lower urine frequency and darker urine color were associated with UTs in this population. Workers who do not have a water bottle at the workplace reported a lower beverage intake, higher UTs and UTI prevalence. Non-WB participants that perceived work barriers to adequate hydration had a higher prevalence of urinary problems.

P0325FREQUENCY AND PREDICTORS OF NON URINARY INFECTIONS AMONG THE ADULT PATIENTS WITH STERILE PYURIA ATTENDED IN NEPHROLOGY DEPARTMENT OF BSMMU, BANGLADESH

Abstract Background and Aims Urinalysis is a test commonly ordered, especially when the patient has a febrile illness. In most cases it provides useful information, but it can sometimes be misleading. A significant proportion of patients with acute febrile illness have transient pyuria without bacteuria. Identification and management of such cases could be improved by better predictive models.To determine predictors of non urinary infections in adult patients with sterile pyuria and to develop a preliminary predictive model. Method This cross sectional study was done in the department of Nephrology, BSMMU, during the period of September 2016 to August 2017. All adult patients with sterile pyuria were included in the study. A total number of 233 cases who had urinary WBCs &amp;gt;5 per high power field (HPF) with a negative culture were selected as sample by convenient sampling technique. We performed detailed clinical and laboratory investigations to identify potential causes of the sterile pyuria. Patients were then divided into two groups, those with causative factors within the urinary tract and those with causative factors outside of the urinary tract. Logistic regression was used to create a model to predict causative group. Results Most 196(84.1%) patients were found to have disorders related to urinary tract (Group A) and 37(15.9%) patients had infections outside of the urinary tract (Group B). Significant proteinuria and urinary casts were more common in Group A, while urinary WBCs&amp;gt;20/hpf and microscopic hematuria were more common in Group(B). All of these differences were statistically significant (p&amp;lt;0.05). In the logistic regression model patients with sterile pyuria with fever (OR 32.9) and/or pyuria with urinary WBC&amp;gt;20/HPF (OR 2.14) were more likely to involvement outside of the urinary tract. Those with urinary tract symptoms (OR 0.28) and/or proteinuria (OR 0.20) were more likely to have renal and urinary tract involvement. Conclusion In patients attended to the nephrology department, sterile pyuria was more likely to have its origin in the urinary tract if there were urinary tract symptoms and/or proteinuria and less likely if there was fever or urinary WBCs &amp;gt;20/hpf. Figure: Diagnosis of the study population (n=233) Figure : Bar diagram shows renal status of the study population P=0.047 P value reached from chi square test Multivariable logistic regression analysis for infections outside the urinary tract

P1050THE EFFICACY AND RENAL SAFETY OF SWITCHING FROM DAPAGLIFLOZIN TO EMPAGLIFLOZIN IN PATIENTS WITH TYPE 2 DIABETES

Abstract Background and Aims Both dapagliflozin (DPG) and empagliflozin (EPG) are highly selective sodium-glucose cotransporter-2 (SGLT-2) inhibitors that inhibit glucose reabsorption and increase its excretion in urine. Previously, DPG was limited to patients with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2, while EPG can be used for those with an eGFR ≥ 45 mL/min/1.73 m2. Therefore DPG was switched to EPG in many patients when eGFR decreased. However, the clinical efficacy and safety of these switches are not clear. In this study, we compared the efficacy and renal safety between patients switching from DPG to EPG and those continuing DPG in patients with type 2 diabetes mellitus (T2DM). Method This retrospective observational study included patients with T2DM who were treated with DPG for more than 6 months. This study included patients who switched to EPG and those who continued using DPG. All other hypoglycemic drugs were maintained at the same dosage before and after the study period. The primary outcome measure was the change in hemoglobin A1c (HbA1c) level after 6 months. The EPG group was evaluated for whether the hypoglycemic effect remain effective after drug switching. Patients with HbA1c levels at or lower than the baseline value after 6 months were defined as effective and patients with levels higher than the baseline were defined as invalid. Safety was evaluated by comparing the difference of eGFR between the baseline value and six months after treatment. Results This study included 169 patients. Among them, 72 patients continued DPG and 97 patients switched to EPG. HbA1c level decreased significantly only in EPG group. In EPG group, 59 patients belong to the effective group (60.8%) and 38 patients were invalid (39.2%). There was no significant change in eGFR after treatment in both groups. Ten patients in DPG group develop adverse reactions (three patients felt uncomfortable and seven patients had urinary tract symptoms), but all continued treatment. In EPG group, five patients lacked follow-up records during the study period and it was difficult to determine whether the patient’s willingness to continue treatment was affected by adverse reactions. Conclusion Our study showed that switching from DPG to EPG in patients with T2DM was effective for blood glucose maintenance and caused no significant changes in renal function. In addition, no severe drug-related adverse reactions were found.

1121 Nonmotor Symptoms Affect Sleep Quality in Early-Stage Parkinson’s Disease Patients With or Without Cognitive Dysfunction

Abstract Introduction Parkinson’s disease (PD) patients frequently present with sleep disorders. This study was designed to assess the impact of nonmotor symptoms (NMSs) on subjective sleep quality in early-stage PD patients with and without cognitive dysfunction. Methods A sample of 389 early-stage PD patients (Hoehn and Yahr score ≤2.5, duration ≤5 years) was recruited for the present study. The Non-Motor Symptoms Questionnaire (NMS-Quest) was used to screen for global NMSs. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HAMD). PD motor symptoms were measured with the Unified PD Rating Scale (UPDRS), part III. The Montreal Cognitive Assessment (MoCA) was used to evaluate global cognitive status, and the PD Sleep Scale (PDSS) was used to quantify sleep quality. Logistic regression models were built to identify factors associated with sleep disturbances. Results In our sample, approximately one-quarter of the PD patients suffered from sleep disturbances (23.7%). Our results also confirmed the high prevalence of cognitive dysfunction in patients with PD (39.8%). In total, the patients who suffered from NMSs, such as depressive symptoms, anxiety symptoms, urinary tract symptoms and hallucinations/delusions, had poorer sleep quality. Better cognition may protect against sleep disorders. In patients with cognitive dysfunction, the NMS-Hallucinations/delusions score was the most important risk factor for sleep disorders. In patients without cognitive dysfunction, NMSs such as anxiety and cognition and medication were related to sleep disorder. Conclusion NMSs in early-stage PD are highly associated with and are determinants of subjective sleep quality. Future studies should focus on elucidating the pathophysiology of these symptoms. Support Special Funds of the Jiangsu Provincial Key Research and Development Projects (grant No. BE2018610)