Urinary Tract System Research Articles

Molecular mechanisms of Escherichia coli pathogenicity

Escherichia coli is a remarkable and diverse organism. This normally harmless commensal needs only to acquire a combination of mobile genetic elements to become a highly adapted pathogen capable of causing a range of diseases, from gastroenteritis to extraintestinal infections of the urinary tract, bloodstream and central nervous system. The worldwide burden of these diseases is staggering, with hundreds of millions of people affected annually. Eight E. coli pathovars have been well characterized, and each uses a large arsenal of virulence factors to subvert host cellular functions to potentiate its virulence. In this Review, we focus on the recent advances in our understanding of the different pathogenic mechanisms that are used by various E. coli pathovars and how they cause disease in humans.

The use of vascularized jejunum flap for vaginal reconstruction: Clinical experience and results in 22 patients

The ideal reconstructive method for a vagina should provide a durable, stable coverage, a patent tube passage for sexual intercourse, and a natural esthetic contour, while simultaneously minimizing morbidity in both the recipient and donor sites, and should be a single stage procedure obviating the use of stents, obturators, and lubrication. Twenty-two patients with absence of the vagina underwent vaginal reconstruction using the jejunal segment transfer technique. Two flaps required re-operation due to venous compromise postoperatively. The flaps were salvaged with venous anastomosis revisions. The overall flap success rate was thus 100%. No urinary tract or gastrointestinal system complication was observed in any case, nor any instance of vaginal introitus. The average follow-up period was 19 months (between 3 and 48 months). Both the depth and diameter of the neovagina were satisfactory postoperatively. After the immediate postoperative period, the only major and embarrassing problem was hypersecretion of the jejunal segment, but this gradually diminished, especially after the first 3 months. Those patients who engaged in sexual intercourse reported good patency and had no complaints in that regard. In conclusion with its evident advantages, the jejunal segment can serve as a reliable option for vaginal reconstruction. It provides quite satisfactory results from both the cosmetic and functional points of view.

Tuberculosis of the urinary tract and male genitalia—a diagnostic challenge for the family practitioner

AbstractTuberculosis (TB) of the urinary tract and male genital system can be very difficult to diagnose unless a high index of suspicion is maintained. The most common presenting features of urogenital tuberculosis (UGTB) are lower urinary tract symptoms (LUTS), haematuria, recurrent urinary tract infection (UTI) by Gram-negative organisms, flank pain, and scrotal swelling. The classically described sterile pyuria should arouse suspicion of UGTB, but in about a third of patients a Gram-negative organism is cultured from the urine, so recurrent bacterial UTI should always be further investigated. Intravenous pyelography (IVP) remains the best imaging study available to screen for UGTB, but ultrasound and computerised tomography (CT) imaging can also be useful. The diagnosis of UGTB is most often confirmed with urine culture: at least 3–5 early morning urine specimens must be submitted and the results may take 4–6 weeks. Histological diagnosis on bladder or testicular biopsies can be made if granulomatous ...

Primary tuberculosis of glans penis: a case report.

An extremely rare form of genitourinary tract tuberculosis (TB) is TB of glans, being reported in 139 cases up to 1971.(1-4) Penile glans may be affected through different mechanisms(1,2,4,5): primary, as an ulcerative lesion of glans; secondary, which is due to TB of other parts in urinary tract system--usually extended through urethra; and finally, hematogenous. Long ago, circumcision was a risk factor when mycobacterium could enter the wounded glans from affected circumcision operators.(3,6) At present, TB of glans in adults is usually a primary or secondary form. Primary glans TB can be acquired by either intercourse with a patient suffering from genital TB, or contact with contaminated fabric. The secondary form is the subsequent complication of lung tuberculosis or other organs involvement.(3) We report a case of primary glans TB, which is, to our best knowledge, the first report in Iran.

Prenatal Sonographic Diagnosis of Rubinstein-Taybi Syndrome

Rubinstein-Taybi syndrome (RSTS; Online Mendelian Inheritance in Man 180849, http://www.ncbi.nlm.nih.gov/sites/entrez?db=omim) is a rare genetic multisystem disorder characterized by mental retardation, broad and often angulated thumbs and halluces, and distinctive facial features. 1 Congenital heart abnormalities, including a patent ductus arteriosus, septal defects, and aortic coarctation, have been reported in up to 33% of affected patients. 2 In a minority of cases, other systemic anomalies involving the skin, eye, ear, central nervous system, urinary tract, and musculoskeletal system, as well as an increased risk of developing tumors, have also been described. 3 The reported incidence of this condition ranges from 1 per 100,000 to 1 per 125,000 live births. 3 Although RSTS is categorized as an autosomal dominant disorder, most reported cases are sporadic, deriving from de novo mutations at a locus on band 16p13.3, which encompasses the gene for the transcription cofactor cyclic adenosine monophosphate response element-binding protein-binding protein. 4 This protein is ubiquitously expressed as a coactivator in cyclic adenosine monophosphate-regulated gene expression, which explains the multisystem problems described in affected individuals. The psychosocial prognosis of the syndrome is quite poor because of mental retardation, varying from a moderate to severe degree, and the considerable morbidity due to associated congenital abnormalities. The diagnosis of RSTS is usually made at birth or during infancy and is still essentially clinical. In fact, even with modern molecular genetic testing, a cytogenetic or molecular abnormality can be found in about 55% of affected individuals, thus leaving the diagnosis to rest on clinical features only in most cases. 4 Despite the fact that the acral abnormalities featured in these individuals might be detectable on sonography, as well as the abnormal profile due to the beaked nose, no prenatal description of RSTS has been reported in literature to the best of our knowledge. We report a case in which the diagnosis of RSTS was hypothesized prenatally after sonographic detection of highly suspicious findings in a family without any previous known risk for this condition.

Rapid Efficacy of the Highly Selective α 1A-Adrenoceptor Antagonist Silodosin in Men With Signs and Symptoms of Benign Prostatic Hyperplasia: Pooled Results of 2 Phase 3 Studies

Rapid Efficacy of the Highly Selective α 1A-Adrenoceptor Antagonist Silodosin in Men With Signs and Symptoms of Benign Prostatic Hyperplasia: Pooled Results of 2 Phase 3 Studies

TGFβ-1 and epithelial-mesenchymal interactions promote smooth muscle gene expression in bone marrow stromal cells: Possible application in therapies for urological defects

For regenerative and cellular therapies of the urinary tract system, autologous bladder smooth muscle cells (SMCs) have several limitations, including constricted in vitro proliferation capacity and, more importantly, inability to be used in malignant conditions. The use of in vitro (pre-)differentiated multipotential adult progenitor cells may help to overcome the shortcomings associated with primary cells. By mimicking environmental conditions of the bladder wall, we investigated in vitro effects of growth factor applications and epithelial-mesenchymal interactions on smooth muscle gene expression and on the morphological appearance of adherent bone marrow stromal cells (BMSCs). Transcription growth factor beta-1 (TGFbeta-1) upregulated the transcription of myogenic gene desmin and smooth muscle actin-gamma2 in cultured BMSCs. Stimulatory effects were significantly increased by coculture with urothelial cells. Prolonged stimulation times and epigenetic modifications further enhanced transcription levels, indicating a dose-response relationship. Immunocytochemical staining of in vitro-differentiated BMSCs revealed expression of myogenic protein alpha-smooth muscle actin and desmin, and changes in morphological appearance from a fusiform convex shape to a laminar flattened shape with filamentous inclusions similar to the appearance of bladder SMCs. In contrast to the TGFbeta-1 action, application of vascular endothelial growth factor (VEGF) did not affect the cells. The combined application of TGFbeta-1 and epithelial-mesenchymal interactions promoted in vitro outgrowth of cells with a smooth muscle-like phenotype from a selected adherent murine bone marrow-derived cell population.

Effects of Long-Term Dietary Soy Treatment on Female Urethral Morphology and Function in Ovariectomized Nonhuman Primates

Agonistic effects of estrogen on the female urethra include an increase in contractile function, blood flow and mucosal hyperplasia. Whether such effects can be achieved by soy based phytoestrogen diets is unclear. We studied the effects of chronic phytoestrogen treatment on the structural and functional properties of the urethra in ovariectomized monkeys. Following ovariectomy 18 monkeys were fed a diet containing soy (9) or casein (9) based protein for 32 months. At necropsy the urethra and bladder were removed and the urethra was separated into 3 segments of equal length, including a proximal, a middle and a distal segment. Each urethral segment and 1 bladder segment was tested in vitro for functional responses to electrical field stimulation and pharmacological stimulation, and the proximal to distal segments were tested for urothelial thickness and mucosal area. Electrical field stimulation produced frequency dependent contractile responses in the bladder, proximal and middle segments but not in the distal segment. Carbachol, phenylephrine and endothelin-1 produced concentration dependent contractions in all urethral segments. The maximum response decreased from the proximal to the distal segment (p </=0.05). The maximum response in the proximal and bladder segments to pharmacological stimulation and electrical field stimulation as well as mucosal area and urothelial thickness were significantly higher in the treatment than in the control group (p < or =0.05). Chronic phytoestrogen treatment results in increased responsiveness of the proximal urethra to pharmacological and electrical stimulation, which is associated with an increase in urothelial thickness and mucosal area. This study indicates that dietary soy may have estrogen agonist effects on the urethra and bladder in estrogen deficient females.

Severe Uropathy and Normal Amniotic Fluid Volume in a Male Fetus

The widespread use of sonography as a screening tool for fetal anomalies has facilitated prenatal detection of several fetal conditions characterized by urinary tract dilatation. These conditions are more common in male fetuses and are generally a result of an anatomic defect causing obstruction along the urinary tract system. Although the prognosis of these conditions largely depends on the specific anomaly, several poor prognostic factors have been described. These factors include detection at an early gestational age, bilateral marked dilatation, a persistently obstructed bladder, oligohydramnios causing pulmonary hypoplasia, and the presence of associated fetal or chromosomal anomalies. We report a case in which a male fetus at 14 weeks' gestation had a diagnosis of rapidly progressing bilateral hydronephrosis, massive bladder dilatation, hydroureter, and a surprisingly normal amniotic fluid volume. Serial sonographic surveillance assisted us in obtaining the correct diagnosis, which was important for adequately consulting the patient regarding the fetal prognosis in the affected index pregnancy as well as the likelihood of recurrence in future gestations.

The impact of constipation on the urinary tract system

The rate of constipation and bowel disorders is underestimated in children and adolescence who suffer from functional urinary tract disorders like enuresis and incontinence. The alimentary and the urinary systems act with a close anatomical and functional relation, malfunctioning of either system will affect the other. Children and adolescents with urinary dysfunctional symptoms have a higher rate of bowel disorders, including constipation and soiling, and vice versa. Assessment and treatment should always include both systems. Failure to detect and treat bowel problems will greatly reduce the success rate in the treatment of urinary symptoms. Dysfunctional symptoms in childhood could be a risk factor for increased rate of constipation and incontinence in adolescence and adulthood. This paper describes the normal development of voiding and defecation control, the effect of bowel disorders on the urinary system, and offers advice concerning the assessment and management of these patients.

Identification and characterization of a novel protein ISOC2 that interacts with p16INK4a

p16INK4a is a multiple tumor suppressor, playing an important role in proliferation and tumorigenesis. To screen the p16INK4a-associated proteins, we performed a yeast two-hybrid assay and identified a novel protein isochorismatase domain containing 2 (ISOC2). ISOC2 conserves in different species, and encodes 205 and 210 amino acids in human and mouse, respectively. The expression of ISOC2 in mouse is universal but predominantly in uterus, stomach, and urinary tract system. Interaction between ISOC2 and p16INK4a was verified using in vitro pull-down assays and in vivo co-immunoprecipitation. Confocal microscopy studies using green and cyan fluorescent fusion proteins determined that ISOC2 co-localizes with p16INK4a. Over-expressed ISOC2 is able to inhibit p16INK4a in dose-dependent manner. Our data indicated that ISOC2 is a novel functional protein, which is able to bind and co-localize with a tumor suppressor gene p16INK4a. Over-expressed ISOC2 inhibits the expression of p16INK4a, suggesting that this novel gene may play a role during the tumor development by interacting with p16INK4a.

Angiotensin II Type 2 Receptor Gene Polymorphism in Caucasian Children With a Wide Spectrum of Congenital Anomalies of the Kidney and Urinary Tract

The A-1332G transition of the angiotensin II type 2 receptor (AT2R) gene was found to occur more often in males with ureteropelvic (UPJO) or ureterovesical junction obstruction (UVJO). However, other studies have shown controversial results. Tauhe frequency of this polymorphism was investigated in 275 Caucasian children (153 boys, 122 girls) with a wide spectrum of congenital anomalies both of upper (165) and lower (110) urinary tract system and in 200 controls (100 boys, 100 girls). Among the included malformations, renal agenesis and duplex collecting system (DCS) were studied for the first time. The frequency of the G allele did not differ among patients (193 of 397 total alleles, 48.6%) and controls (146 of 300, 48.7%). No significant difference was also found in the frequency of the G allele in subgroups of congenital uropathies compared with controls. When analysis was performed in males and females separately, no significant difference was found in the frequency of the G allele in male (45.1%) or female (50.8%) patients compared with male (57.0%) or female (44.5%) controls. Our data indicate that the AT2R gene A-1332G transition is not associated with the development of human congenital uropathies and further investigations should be carried out to unravel their etiology.

Pharmacology of α1-adrenoceptor antagonists in the lower urinary tract and central nervous system

The main use of alpha(1)-adrenoceptor (AR) antagonists in urology has been to treat lower urinary tract symptoms (LUTS) in men with benign prostatic obstruction (BPO). The beneficial effects of these agents are primarily assumed to be because of relaxation of prostatic and urethral smooth muscle. The weak correlation between LUTS and prostatic enlargement, outflow obstruction, or both, however, has refocused interest on the role of extraprostatic alpha-ARs in the pathogenesis of LUTS and their treatment. The alpha(1)-ARs present in the bladder, urethra, vas deferens, peripheral ganglia, nerve terminals, and in the central nervous system could all potentially influence LUTS and, when the receptors are blocked, contribute to both the therapeutic and adverse effects of alpha(1)-AR antagonists. The relevance of alpha(1)-AR-subtype selectivity on the clinical usefulness of existing drug therapies has not been firmly established but it seems that blockade of both alpha(1A/L)- and alpha(1D)-ARs is necessary for the optimum balance between clinical efficacy and adverse effects.

The effect of dilated ganglionic segment on anorectal and urinary functions during 1-stage transanal endorectal pull through for Hirschsprung's disease

Background/Purpose During a 1-stage transanal endorectal pull through (OS-TERP) for Hirschsprung's disease (HD), dilated ganglionic segment (DGS) may pose a problem during coloanal anastomosis. Apart from the anorectal problems occurring after the HD operations, lower urinary tract problems may also be encountered. The anorectal and lower urinary tract system functions of the patients that underwent OS-TERP in the presence of DGS were evaluated. Method From 2000 to 2005, 15 patients (14 boys and 1 girl) underwent OS-TERP for HD. During the presence of DGS, the coloanal anastomosis of the DGS was completed without any tapering or excision. Hospital and digital video records of all the patients who underwent OS-TERP were evaluated, and the operation time, complications, and follow-up periods of the patients were compared. Standard urodynamic studies were performed after at least 6 months. Bladder capacity; mean bladder capacity ratio; maximum filling pressure; the number of contractions during the filling phase; intraabdominal, intravesical, and detrusor pressures; residual urinary volume; and electromyography activities of the pelvic floor muscles were evaluated. Results Six patients had ganglionic segment of normal caliber, whereas 9 patients had DGS. Duration of the operation was significantly longer in the DGS group. One patient in DGS group experienced a single episode of enterocolitis in the postoperative period. Transient urinary retention occurred in another patient in DGS group. In ganglionic segment of normal caliber group, one patient experienced 2 episodes of enterocolitis in the postoperative period. Urodynamic study of the 7 patients in the DGS group had postvoiding urine volume of less than 20 mL. The detrusor activities of all the patients were found to be normal. None of the patients had developed urinary tract problems during the follow-up period. Conclusion With the coloanal anastomosis technique, we have described that narrowing the DGS to anal caliber step by step without any excision or tapering enables DGS to fit to the anus easily. Although further clinical studies with larger sample sizes are necessary, present study may imply that OS-TERP performed in the presence of a DGS may not increase morbidity and affect anorectal functions. The normal urodynamic study results obtained in this study may imply that OS-TERP procedure may be performed safely in the presence of DGS.

Serum biochemical abnormalities in goats with uroliths: 107 cases (1992–2003)

To characterize serum biochemical abnormalities in goats with uroliths. Retrospective case-control series. 107 male goats with uroliths and 94 male goats with various nonrenal diseases (controls). For male goats, results of serum biochemical analyses collected from 1992 through 2003 were retrieved from computerized records, as were signalment, clinical diagnoses, and discharge status. Results of analyses for BUN, creatinine, phosphorus, calcium, Na, K, Cl, total CO2, anion gap, and glucose were compared between goats with uroliths and control goats. Goats with uroliths had higher mean BUN, creatinine, total CO2, K, and glucose concentrations and lower mean phosphorus, Na, and Cl concentrations than control goats, with no difference in mean calcium concentration and anion gap. Goats with uroliths had higher frequency of azotemia, hypophosphatemia, hypochloridemia, and increased total CO2 and lower frequency of decreased total CO2 than control goats. Urolithiasis occurred more frequently in castrated males than in sexually intact males and in dwarf African breeds than in other breeds. Goats with uroliths often had hypophosphatemia at admission. Hypochloridemic metabolic alkalosis was the most common acid-base disorder. Rupture in the urinary tract system was associated with increased prevalence of hyponatremia and hyperkalemia. Clinicians should be aware of these abnormalities when determining fluid therapy.

Adult Genitourinary Sarcoma: The 25-Year Memorial Sloan-Kettering Experience

Urological sarcomas are rare. We describe a continued single institutional experience during 25 years. The records from July 1977 to July 2003 were reviewed of all patients at our institution with sarcoma arising in the urinary tract or male genital system who were 16 years or older at diagnosis. The primary tumor site in 131 patients was the bladder in 20, the kidney in 26, paratesticular in 57, the prostate in 21 and other in 7. Median followup was 4.0 years. The most common histological subtypes were leiomyosarcoma in 29% of cases and liposarcoma in 26%. Median tumor size was 7 cm and 78% of lesions were high grade. Of the patients 28 (21%) presented with metastatic disease and their median survival was 1.4 years compared to 10.7 years in patients without metastatic disease (p < 0.0001). Disease specific survival was 56% and 42% at 5 and 10 years, respectively and median survival was 7.6 years. On univariate analysis unfavorable prognostic variables for disease specific survival were metastasis at presentation, high tumor grade, a lack of leiomyosarcoma and liposarcoma histological subtypes, prostate sarcoma and large tumor size, incomplete surgical resection and positive surgical margin. Patient sex, age and surgical margin status were not significant predictors. On multivariate analysis 2 variables remained significant predictors of disease specific survival, including tumor size (HR 1.1, 95% CI 1.02 to 1.17) and absent metastasis at diagnosis (HR 4.9, 95% CI 1.4 to 17.2). Predictors of disease specific survival include local disease at presentation, complete tumor resection and tumor grade, size, location and histological subtype. With adequate surgical treatment most patients who presented with primary disease and underwent complete surgical resection achieved prolonged disease specific survival.

Traditional medicinal plant use in Loja province, Southern Ecuador

This paper examines the traditional use of medicinal plants in Loja province, Southern Ecuador.Two hundred fifteen plant species were collected, identified and their vernacular names and traditional uses recorded. This number of species indicates that the healers, market vendors and members of the public interviewed still have a very high knowledge of plants in their surroundings, which can be seen as a reflection of the knowledge of the population in general. However, the area represents only an outlier of the larger Northern Peruvian cultural area, where more than 500 species of plants are used medicinally, indicating that in Ecuador much of the original plant knowledge has already been lost.Most plant species registered are only used medicinally, and only a few species have any other use (construction, fodder, food). The highest number of species is used for the treatment of "magical" (psychosomatic) ailments (39 species), followed by respiratory disorders (34), problems of the urinary tract (28), Fever/Malaria (25), Rheumatism (23) and nervous system problems (20).

Asymptomatic bacteriuria in type 2 Iranian diabetic women: a cross sectional study

BackgroundThe risk of developing infection in diabetic patients is higher and urinary tract is the most common site for infection. Serious complications of urinary infection occur more commonly in diabetic patients. To study the prevalence and associates of asymptomatic bacteriuria (ASB) in women with type 2 diabetes mellitus in the Iranian population, this study was conducted.MethodsBetween February 10, 2004 and October 15, 2004; 202 nonpregnant diabetic (type 2) women (range: 31 to 78 years old) with no abnormalities of the urinary tract system were included in this clinic based study. We defined ASB as the presence of at least 105 colony-forming units/ml of 1 or 2 bacterial species, in two separated cultures of clean-voided midstream urine. All the participants were free from any symptoms of urinary tract infection (UTI). Associates for developing bacteriuria was assessed and compared in participants with and without bacteriuria.ResultsIn this study, the prevalence of ASB was 10.9% among diabetic women. E. coli was the most prevalent microorganism responsible for positive urine culture. Most of the isolated microorganisms were resistant to Co-trimoxazole, Nalidixic acid and Ciprofloxacin. Pyuria (P < 0.001) and glucosuria (P < 0.05) had a meaningful relationship with bacteriuria but no association was evident between age (P < 0.45), duration of diabetes (P < 0.09), macroalbuminuria (P < 0.10) and HbA1c level (P < 0.75), and the presence of ASB.ConclusionThe prevalence of ASB is higher in women with type 2 diabetes, for which pyuria and glucosuria can be considered as associates. Routine urine culture can be recommended for diabetic women even when there is no urinary symptom.

Inflammation of the Gonad in Prepubertal Healthy Children. Epidemiology, Etiology, and Management

The prevalence, etiology, and proper management of acute gonadal inflammation in prepubertal children are still controversial, with some reports defining it as rare, while others have found it more prevalent. So far, there is no consensus on imaging studies or standard follow-up procedures. In the minority of the children, the inflammation is related to congenital genitourinary malformation and bacterial infection. The majority of children with gonadal inflammation are healthy and do not have any underlying malformations; in this group, the etiology is related to viral infection or torsion of the gonad appendix. Management is directed towards the etiology. Hence, when bacterial inflammation is suspected, antibiotics should be given and full evaluation of the urinary tract system should be performed. For patients with negative medical history, absence of fever, and normal urinalysis, the diagnosis of bacterial inflammation is very unlikely, and there is neither justification for antimicrobial antibiotic therapy nor for any further urinary tract imaging. Caution should be taken with nonverbal children and infants, or patients with any abnormal parameter. For these patients, we recommend initial management as for bacterial urinary tract infection, until urine cultures results are obtained. This paper provides a comprehensive review with the related medical literature.

Focusing on the ethnobotanical uses of plants in Mersin and Adana provinces (Turkey).

This paper presents the result of a study on the herbal drugs in the herbal markets in Mersin and Adana. The data were collected through direct interviews with herbalists and customers between 2002–2005 and the popular medicinal plants were investigated. A total of 107 species belonging to 56 families were investigated and the samples were listedwith their local and Latin names. The investigation includes cross-checking the disorders and their herbal cures and their recommended use stated by the local herbalists, by the parts used, and by the preparations. The cultivated species and their ethno botanical uses, are documented and extensive inventory is presented.As a result, we observed that these plants are used especially for intestinal digestive disorders of the gastrointestinal tract, (21.68%), respiratory tract system disorders (10.43%), heart-blood circulatory system disorders (8.48%), urinary tract system disorders (7.70%), skin disorders (6.48%) and others.