Difficulty In Urination Research Articles

Management of Impacted Urethral Calculi: An Uncommon Cause of Acute Urine Retention in North-western Nigeria

Urethral stones though rare manifestation of urolithiasis may be primary but mostly are secondary arising from either the urinary bladder or the upper tract. When impacted in the urethra may result in acute urinary retention and difficulty in urethral catheterization. Various treatment modalities are available ranging from initial suprapubic cystostomy and subsequent open surgical or endoscopic procedures as well as treatment of associated urethral pathology. We report our experience in the management of patients with acute urine retention due to impacted urethral calculi in a tertiary hospital. This was a retrospective review of forty patients with impacted urethral stones managed at the Urology Unit, Department of Surgery Usmanu Danfodiyo University Teaching Hospital Sokoto from January 2005 to December 2015. Data were collected from patients’ case notes and entered in to a proforma and analysed using SPSS 20.0 version for Windows. Forty patients comprising of one female (2.5%) and 39 males (97.5%), mean age was 25±17.4 years with a range of 1-63yrs. In twenty patients (50%), attempt at urethral catheterization was not successful. Location of the impacted calculi were meatal 7 (17.5%), distal penile 4 (10%), mid penile 8 (20%), proximal penile 1 (2.5%), bulbar 4 (10%), peno-bulbar junction 3 (7.5%), posterior urethra 11 (27.5%), and bladder neck 2 (5%). Spontaneous extrusion of the calculi occurred in 4 (10%), while expulsion occurred in 2 (5%) after intra-urethral instillation of 2% lidocaine jelly. Other treatment modalities in the remaining patients included; meatotomy 11 (27.5%), open urethrolithotomy 6 (15%), urethroscopy and pneumatic lithotripsy 6 (15%), urethroscopy and stone retrieval 1 (2.5%), urethrolithotomy and urethroplasty 2 (5%), and cystolithotomy 8 (20%). Impacted urethral stone may be a cause of acute urinary retention and failed urethral catheterisation. The stone can pass spontaneously with or without manipulation or can be removed by endoscopic or open technique when spontaneous passage is not successful.

Health System Factors That Influence Health Seeking Behavior Associated With Prostatism among Men above 40 Years in Nyamira County

Background: Prostatism refers to obstruction of the bladder neck due to an enlargement of the prostate as men ages leading to urinary difficulties. Prostatism symptoms are majorly irritative and obstructive. The obstructive ones include hesitancy, the need to initiate micturition and a weakened urinary stream while the Irritative ones which are usually more troublesome to patients includes urgency, frequency as well as nocturia. This study was cross sectional study which was conducted at Nyamira County. Objective: The study sought to establish Health system factors that influence health seeking behavior associated with Prostatism among men above 40 years in Nyamira County. Materials and methods: The study adopted a descriptive cross-sectional community study design. The study utilized qualitative and quantitative research methods in order to obtain the required information from respondents. Quantitative data collection was done by use of open and closed ended questionnaires while qualitative data was collected through focused group discussions with adult Men. Confidentiality of information collected was observed and consent was sought from the respondents before collecting any form of information from them. A total of 387 respondents from 18 villages representing 3 villages from six sub locations of Nyamira south and Masaba wards that were randomly selected, were interviewed representing 91.7% response rate. The tools that the researcher used included questionnaire, interview schedule, pens and pencils. Descriptive data was analyzed with the aid of the Statistical Package for Social Sciences (SPSS) version 20.0 with the help of Microsoft Excel programme to generate frequency tables, graphs and pie-charts. Inferential statistics was calculated using Chi-Square tests (p=0.005) done at 95% confidence level to determine the linkage between the Variables. Results: The study found that the overall uptake level of Prostatism services was 12.1%. Chi-square analysis revealed significant relationship between cost of screening (0.001), having medical insurance (0.001), reception and quality of care (0.01), distance to health facility (0.001) and uptake of Prostatism services. Conclusion: The study findings revealed a low uptake of prostatism services. The findings of this study will help policy makers, facility administrators and care providers to shape comprehensive healthcare policies and programs targeting Prostatism services. This will help come up with a policy specifically addressing health system factors that affect uptake of prostatism services.

Sonourethrogram in comparison with retrograde urethrogram in evaluation of male anterior urethra

Objective: Imaging of anterior male urethra is usually done using retrograde urethrogram, which utilises radiation. This study utilises high resolution ultrasound which is radiation free and helps to understand urethral pathologies like strictures, chronic urethritis etc. This study also compares the utility of sonourethrogram with retrograde urethrogram and provides the advantages of using sonourethrogram. Also establishes the drawbacks of using sonourethrogram over retrograde urethrogram. Material & Methods: This study was done on 60 patients, came with different complaints like difficulty in micturition, obstructed urinary stream, pain in penis, increasing frequency of micturition and referred to us for retrograde urethrogram. Patients were examined with high resolution ultrasound with due permissions. Results are compared with findings of retrograde urerthrogram. Results: Out of 60 patients, 59 had strictures shown in retrograde urethrogram either in penile, bulbar or membranous parts. Only one patient had membranous urethral stricture in retrograde urethrogram which was not shown in sonourethrogram. All other patients have shown strictures in sonourethrogram. One patient had penile urethral calculus shown in both sonourethrogram and retrograde urethrogram. Conclusion: Sonourethrogram is equally effective as that of retrograde urethrogram especially in anterior urethral strictures. However, it underestimates or less useful in evaluation of posterior male urethral pathologies. Sonourethrogram is easily available, cost effective technique that uses no radiation in the evaluation of male urethra. It is equally effective compared to retrograde urethrogram in the evaluation of male anterior urethral strictures. Periurethral pathologies like fibrosis are better evaluated with sonourethrogram than with retrograde urethrogram. It is also important in the surgical planning and approach.

Analysis of urodynamic study of female outpatients with lower urinary tract symptoms and follow-up of the patients with detrusor underactive

Objective To find out the prevalence of lower urinary tract symptoms (LUTS) and analyze the characteristics of the urodynamics diagnosis in female outpatients. To study the natural history of detrusor underactive (DU) by the followed up. Methods A retrospective study of the female LUTS outpatients in Peking University People's Hospital from Jan. 2005 to Dec. 2015 was performed. The basic information and the urodynamic results of a total of 656 female outpatients were collected. The distribution of storage symptoms, voiding symptoms, complications and urodynamic diagnosis were analyzed. The symptoms and urodynamic results were compared among the groups, which were divided according to age, urodynamic diagnosis and diabetes mellitus. A follow-up of 163 female DU outpatients was performed, including the treatments and the American Urological Association symptoms scores (AUAss). Results Frequency (25.03%) is the most common symptom in female outpatients, followed by stress urinary incontinence (20.04%), urgency (19.97%), and difficulty of voiding (17.32%). Stress urinary incontinence (SUI) accounted for the first (36.04%) of the whole outpatients, followed by the DU (24.08%), and bladder outlet obstruction (17.58%). The patients aged 51-60 years occupied the peak of almost all the diagnosis. There was a higher proportion of the young female patients than that of the middle and old patients diagnosed with no abnormal after the urodynamic study. The first, strong, urge and maximum bladder capacity were significantly larger in DU patients with diabetes than without diabetes. Follow-up results of the DU patients showed there was no significantly difference of the AUAss scores in both the two groups before and after the follow-up, but the quality of life decreased significantly. Conclusion Female LUTS outpatients showed a main complaint of storage symptoms. SUI ranked the first in female patients with LUTS. With the increase of age, bladder sensation and detrusor function decrease. In elderly patients, DU became the first ranked disease instead of SUI. Diabetes can affect the sensory function of bladder in patients with DU, and then increase the difficulty of voiding. The patients with DU, absent from treatment, experienced a lower quality of life.

A prospective study of uroflowmetry in 100 patients with lower urinary tract symptoms

Background: Uroflowmetry is diagnostic procedure of various urinary tract diseases like urethral stricture, benign prostatic hyperplasia, neurogenic bladder, detrusor muscle overactivity by calculating the rate of urine expulsion against the time unit in second. Uroflowmetry is simple and non-invasive diagnostic method.Methods: This is a prospective study of 100 cases which fulfil inclusion and exclusion criteria. After taking informed written consent of the patients, they have gone under uroflowmetry study by Urocap 3 uroflowmeter, and graphs were obtained and result analysed.Results: Maximum number of patients has prolonged curve graph were diagnosed as benign prostate hypertrophy (BPH) (53%), dysfunctional voiding curve for detrusor overactivity (20%) intermittent flow curve for neurogenic bladder (7%), Box variety for urethral stricture (7%).Conclusions: In present study we found that uroflowmetry is helpful in diagnosis of certain urological pathologies. Common lower urinary symptoms were burning micturition, frequency and difficulty in micturition. Age group from 50-70 years was often presented with bladder outflow obstruction. Uroflowmetry overall useful in diagnosis of BPH and urethral stricture which can be supported by ultrasonography of prostate with PVRV and RGU respectively to avoid other invasive and more difficult pressure or flow urodynamic study.

Primary intradural extramedullary spinal mesenchymal chondrosarcoma: case report and literature review

BackgroundMesenchymal chondrosarcoma (MCS) is a rare malignant variant of chondrosarcoma with a high tendency of recurrence and metastasis. Intradural extramedullary spinal MCS is exceedingly rare and usually found in pediatric patients. Herein, we present an elderly patient with primary intradural extramedullary spinal MCS. Relevant literatures are reviewed to disclose characteristics of intradural extramedullary spinal MCS.Case presentationA 64-year-old female presented with urinary difficulty and tightness of upper back preceding progressive weakness of right lower extremity. Magnetic resonance imaging revealed an intradural extramedullary tumor at the level of 3rd thoracic vertebra. This patient underwent total tumor resection and then received adjuvant radiotherapy. Histopathological examination showed that the tumor composed of spindle and round cells with high nucleocytoplasmic ratio accompanied by scattered eosinophilic chondroid matrix. Along with immunohistochemical findings and the existence of HEY1-NCOA2 fusion transcript, the diagnosis of MCS was confirmed. Neurologic deficit recovered nearly completely after surgery. No evidence of local recurrence or distant metastasis was found 5 years after treatments. Including the current case, a total of 18 cases have been reported in the literature with only one case with local recurrence and one case of mortality. The current case was the eldest patient diagnosed with primary intraspinal MCS in the literature.ConclusionsMCS rarely appears in the intradural space of the spine. In contrast to classic MCS, treatment outcome of primary intradural extramedullary spinal MCS is usually excellent as total tumor resection is commonly achievable. Adjuvant radiotherapy may reduce local recurrence and chemotherapy may be associated with fewer recurrences especially for unresectable tumors.

Multiple symmetric lipomatosis with vulvar involvement: a rare case report associated with walking difficulty and urination disorder

Multiple symmetric lipomatosis (MSL)—a rare metabolic condition characterized by diffuse, nonencapsulated, painless fat deposits—remains a challenging condition to treat. In addition, the clinical manifestation of MSL in women has not been fully understood due to the male-dominated prevalence of the disease. Here, we report a rare case of MSL with vulvar involvement and provide a review of the literature to increase the understanding of both the diagnosis and treatment of the disease. A 46-year-old Japanese woman, who had a history of chronic alcohol consumption for over 20 years, presented with bilateral giant enlargement of the labia major and complained of difficulty in walking and urination. Magnetic resonance imaging revealed nonencapsulated fat deposits involving the vulvar region and extending around the rectum. The patient underwent pubic lipectomy followed by episioperineoplasty, which resulted in a good esthetic outcome with sufficient patient satisfaction. The morphological presentation of MSL in women is different from that in men, and clinical expression of MSL in the vulvar region is rare but cannot be overlooked owing to the potential of serious sequelae such as walking difficulty, urination disorder, and sexual dysfunction. In such cases, lipectomy followed by episioperineoplasty is indicated for the treatment of the condition and its sequelae, while ensuring less chance of relapse and better esthetic outcome compared with other treatment strategies.Level of evidence: Level V, therapeutic, diagnostic, risk/prognostic study.

Concomitant transobturator tape and anterior colporrhaphy versus transobturator subvesical mesh for cystocele-associated stress urinary incontinence.

Stress urinary incontinence (SUI) and cystocele often occur concomitantly and thus may potentially be treated via a single surgical procedure. This study evaluated the efficacy and safety of concomitant transobturator tape (TOT) with anterior colporrhaphy versus subvesical transobturator mesh (TOM) for cystocele-associated SUI. This prospective, clinical trial included women with cystocele-associated SUI. Patients were randomly allocated into either group I (anterior colporrhaphy with concomitant TOT "in-out" fixation) or group II (implantation of a subvesical four-armed TOM). All patients were followed up at 1, 3, 6, 9, and 12months postoperatively. Statistical tests were performed to compare the group outcomes based on objective, subjective, and anatomical variables. There were 81 patients in group I and 83 in group II. Median follow-up duration was 12months. The demographic data and baseline clinical characteristics of both groups were comparable. There were no significant differences between groups regarding the success rates of SUI and cystocele repair. Groups I and II had similar cure rates of SUI (82.9 and 88.4%, respectively; p = 0.369) and incidences of successful cystocele repair (85.4 and 97.7%, respectively; p = 0.055). No urethral or bladder injuries or mesh erosions were reported. Both groups had comparable postoperative complications, except the greater incidence of micturition difficulty in group I than group II, during the early follow-up (12.2% vs. 0.0%; p = 0.024). Transvaginal mesh was not superior to native tissue repair. Anterior colporrhaphy and TOT may be an appropriate alternative to four-armed TOM application for concomitant correction of SUI and cystocele.

B-23 Non-Motor Symptom Profile in Parkinson’s Disease Patients and its impact on Quality of Life

Abstract Objective Non-motor Symptoms (NMS) in Parkinson’s Disease (PD) are known to be diverse and may include cognitive, psychiatric and sleep disturbance, fatigue, and autonomic disorders (e.g., cardiovascular dysregulation, orthostatic hypotension, thermo-dysregulation, sexual dysfunction, urinary and bowel dyscontrol). The aim of this study was to define the NMS profile in a large sample of PD patients with and without Deep Brain Stimulation (DBS) and its impact on quality of life (QOL). Method Cross-sectional, survey-based research design was used. 1,164 individuals with PD participated in this survey: 275 participants who underwent DBS and 889 without DBS. Participants completed the Non-Motor Symptom Scale (NMSS) and answered questions assessing the impact of NMS on everyday life. Participants were divided into younger (ages 50-69) and older (ages 70+) age cohorts and disease duration cohorts with early stage ( < 6 years) and advanced stage (6-10 years; 11+ years) groups. Results 24 out of 31 NMS categories were experienced by more than 50% of the participants. Urination difficulty, fatigue, sleep, constipation, and cognitive difficulties were symptoms most frequently reported to adversely impact day-to-day living, and cognitive difficulties followed by sleep disturbance had the strongest impact to quality of life. Conclusions NMS burden drives quality of life for many individuals and has remained a relatively new frontier for exploration, at least in depth and scope as it relates to assessment and treatment of NMS. Management of NMS remains an unmet need for individuals with PD. Implications for neuropsychologists are discussed.

Chronic Lymphocytic Leukemia Presenting as Irritative Lower Urinary Tract Symptoms and Non-Visible Hematuria: An Atypical Urology Presentation

Chronic lymphocytic leukemia (CLL) is an uncommon hematological disease affecting people with recurring infection and is associated with increased risk of progression to high-risk cancer. Bladder CLL is a rare disease hence prognosis and best treatment option is not clearly understood. CLL commonly affects middle-aged women. It presents as abdominal pain, urinary difficulty, fatigue and general symptoms like fever, weight loss and loss of appetite. Chemotherapy, surgery, and radiation is the mainstay of treatment. Prognosis depends on multiple factors including subtype, stage of lymphoma, the progression of the condition, response to treatment, and overall health of the patient. The risk of recurrence and progression to other cancer is very high in bladder CLL which necessitates a strict follow-up protocol. We present a case of an 87-years-old patient presenting with persistent non-visible hematuria and storage lower urinary tract symptoms. Hematuria workup leads to the diagnosis of CLL. Hematology multi-disciplinary team recommended follow up.

Nadir Görülen Bir Olgu Sunumu: Prostatik Üretraya Açılan Üreterde Taş

Ectopic ureter is a rare urological anomaly and is caused by developmental defect of the mesonephric canal and ureter bud in the embryonal period. It is frequently seen with anomalies such as double collecting system and dysplastic kidney. The treatment of this condition, which is more common in women than in men, varies according to the location of the accompanying pathologies, renal function, and ectopic ureter orifice. In this article, we discussed the clinical approach of the patient who presented to our clinic with painful macroscopic hematuria, dysuria, difficulty in urination, and an ectopic ureter opening to the prostatic urethra and accompanying distal ureteral calculi.

Osteochondrodysplasia in a 9-Year-Old Scottish Fold Cat

Abstract Objective The aim of this study was to share clinical and radiological findings of extremely advanced osteochondrodysplasia.A 9-year-old Scottish Fold cat was presented with the complaint of difficulty in urination, defecation, respiration, standing and walking. Physical findings such as kyphosis, hyperflexion of joints and thick tail and, radiological findings including periosteal bone proliferation in distal extremities, ankylosing changes in spine and tail and, calcification of triceps brachii insertion were consistent with the most advanced osteochondrodysplasia ever documented. Antibiotic medications, anti-inflammatory drugs, vitamin C and enema were administered considering difficulty of urination, defecation and respiration. Then, glycosaminoglycans and prednisolone were administered for osteochondrodysplasia and increase in the movement of the cat was observed in a few days. Conclusion By sharing clinical and radiological findings of severe osteochondrodysplasia in advanced age, the importance of informing breeders and owners about uncontrolled breeding of these cats was emphasized.

Leucemia mieloide aguda en adulto mayor comórbido. A propósito de un caso

Caso clínico: paciente masculino de 81 años de edad, con cuadro de 24 horas de evolución secundario a caída, caracterizado por somnolencia, desorientación en persona, tiempo y espacio, incontinencia urinaria y dificultad para la deambulación, motivo por el cual se le efectúa una tomografía simple de cráneo encontrándose hematomas subdurales bilaterales, presenta episodios de sangrado recurrente y leucocitosis sostenida , en frotis de sangre periférica se observó 28% de blastos por lo que se realiza una biopsia de medula ósea descubriéndose un cariotipo medular compatible con leucemia mieloide aguda, debido a sus características clínicas y a su mala evolución fue catalogado como paciente paliativo. Conclusiones: la leucemia mieloide aguda es una patología hematológica cuya evolución al no ser detectada genera un alto grado de mortalidad, sobre todo en el adulto mayor comórbido.

Cure of Underactive and Overactive Bladder Symptoms in Women by 1,671 Apical Sling Operations Gives Fresh Insights into Pathogenesis and Need for Definition Change

Introduction:To check evidence that symptoms identical with those constituting “underactive bladder” (UAB) and “overactive bladder” (OAB) are caused by apical prolapse and cured by repair thereof. Material and Methods: After repair of apical prolapse by mesh tape reinforcement of lax uterosacral ligaments (USL) data form 1,671 women were retrospectively examined to determine the presence of OAB and UAB symptoms and to check, how many were cured surgically. Thereby 3 different techniques were performed: elevate (n = 277), “Posterior IVS” (n = 1,049), and TFS cardinal (CL)/USL (n = 345). Results: Symptoms identical with those comprising UAB and OAB were cured in up to 80% of cases following surgical repair of the CL/USL complex. Conclusions: These symptoms may be consistent with symptoms of the posterior fornix syndrome, which comprises 4 main symptoms: micturition difficulties, urge/frequency, nocturia, chronic pelvic pain, all consequent on USL laxity. Surgical cure of OAB and UAB is inconsistent with existing definitions, which imply pathogenesis of the detrusor muscle itself. A reconsideration and reformulation of existing definitions may be required. Altering UAB definition to “bladder emptying difficulties” and return to former definitions for OAB such as “detrusor” or “bladder instability” may help to restore compatibility with surgical cure of these conditions.

Spondias – an underutilized potential fruit crop of West Bengal

Spondias (hog plum and great hog plum), underexploited members of the Anacardiaceae, are growing widely in India for its edible fruits. These deciduous species are tolerant to drought and growing abundantly as fence side trees in West Bengal. Fruits can be eaten fresh, cooked or made into value added products. Unripe fruits can be made into jelly, pickle, chutney or relishes or used for flavouring sauces, soups and stews. In some places young leaves are eaten raw or steamed as vegetable for eating with salted fish and rice. It may play a vital role in nutritional, neutraceutical and in economy of rural people, which has received little research attention. Fruits are reported to be rich in vitamin A, vitamin C and iron content. The fruits are used to treat heart ailments and urinary troubles and are used on wounds, sores and burns and for digestion. The bark is considered useful in dysentery and diarrhea and is also given to prevent vomiting. The root is considered useful in menstruation. The plant is reported to have anti-tubercular properties. So, there is great scope of increasing socio-economic status of rural and tribal people by exploiting these two species viz., Spondias pinnata (hog plum) and Spondias dulcis (great hog plum). Considering its importance, two species growing in West Bengal were reviewed with an objective of exploiting this crop.

A study on association between inguinal hernia and benign prostatic hyperplasia

Background: Inguinal hernia is the most common cause of abdomen wall hernias with multiple etiological risk factors. Benign prostatic hyperplasia (BPH) is the most important cause of bladder outlet obstruction in elderly males leading to chronic straining and difficulty in micturition, which can precipitate inguinal hernia. The occurrence of both inguinal hernia and BPH with lower urinary tract symptoms increases with age. Some studies show that their occurrence together is considered a chance co-existence rather than cause and effect. This study is aimed to find out whether BPH is a significant risk factor for developing inguinal hernia in males.Methods: This study was conducted at a tertiary care hospital in Chennai. 126 males, aged 40 and above were selected according to inclusion criteria and were divided into two groups viz cases (with inguinal hernia) and controls (without inguinal hernia). IPSS scoring chart, prostate volume and uroflometric analysis were done for both groups and results were compared.Results: IPSS scoring showed 22 cases (35%) and 22 controls (35%) had moderate to severe symptoms and no statistical significance. The mean prostate volume in cases was 22.5 g compared with 22.6 g among controls and was statistically insignificant. 11 cases (17%) and 13 controls (21%) had Qmax value less than 15 and the difference was statistically insignificant.Conclusions: This study shows that, although both inguinal hernia and benign prostatic hyperplasia are seen with increased frequency in the aged male population, there is no statistically significant association between the two. Their occurrence together is considered a chance co-existence rather than cause and effect.

Case report: epidermoid inclusion cyst of the clitoris as a long-term complication of female genital mutilation

BackgroundFemale genital mutilation is a common procedure in sub-Saharan Africa that causes serious short- and long-term complications. Although physicians can overcome these complications sometimes, they can be very confusing to diagnose. In this report, we discuss the surgical management of a patient with an epidermal inclusion cyst of the clitoris as a long-term complication of type III female genital mutilation.Case presentationA healthy 43-year-old African woman who was a nonsmoker and nonalcoholic presented with a large genital mass causing difficulty in urination and sexual discomfort. The patient had three full-term spontaneous vaginal deliveries without any complications. Perineal examination revealed a 6 × 10-cm, well-circumscribed, mobile, nontender, rounded cystic swelling in the right periclitoral area that was obstructing the urinary meatus and vaginal introitus. A surgical procedure was performed for total excision of the clitoral mass. Pathological findings showed an epidermoid inclusion cyst.ConclusionsBesides increasing clinicians’ awareness of female genital mutilation and its long-term complications, public education campaigns should be designed to eradicate this practice.

Treatment of hypospadias in children with urethral plate combined with one crescent flap

Objective To investigate the clinical effect of urethral plate combined with unilateral crescent flap in the treatment of hypospadias in children. Methods The clinical data of 14 cases of hypospadias treated from March 2017 to March 2018 were retrospectively analyzed, with average age of (3.3±2.1) years.The external urethral orifice was located in the middle and distal part of the ventral side of the penis, with mild and moderate bends of the penis.The prepuce was piling up on the penile dorsal side, the ventral skin was deficient, and there was no concomitant disease such as penis scrotum transposition or cryptorchidism.All children were primarily treated with urethroplasty with urethral plate and one crescent flap.One side of the free urethral plate had a crescent superficial fascia, which was used as the new urethral material together with the urethral plate. By design, the urethra sutured deviating from the midline.The external urethral orifice was formed by trimming the anterior opening of urethra in the form of shallow V shape, and the new urethra was covered with the dorsal fleshy vascular pedicle. The pterygoid flap of the penis was sutured to form the penile head, and the foreskin was cut to cover the body of the penis.The specimens were taken for HE staining. Results The operation was successfully completed in 14 children.The length of the penis was measured before it is stretched out.The penile length was(3.5±0.5)cm, the penile diameter was(1.2±0.3) cm at the coronal sulcus, and the diameter of the tortoise head was(1.5±0.3)cm at the pterygoid.The width of urethral plate was(0.6±0.1)cm.Remeasurement was performed after complete correction of penile bending deformity.The length of the penis was(3.5±0.5)cm, and the urethral defect was(1.7±0.7)cm.According to Barcat method, there were 2 cases of coronal sulcus type, 7 cases of anterior penile type and 5 cases of middle penile type. The results of HE staining showed that the number of blood vessels in the dorsal prepuce and fascia was(8.5±2.1), dorsal foreskin plate was (5.1±1.6), ventral prepuce internal plates was(7.6±1.8), and ventral outer prepuce plates was(4.8±1.6). The number of superficial fascia vessels and deep fascia vessels were(10.3±1.4)and (4.2±1.7). The analysis of variance showed that there was significant difference in the mean number among groups(P=0.036), which was compared with each other by SNK-q test.The number of fasciae in dorsal prepuce was the most abundant, there was significant difference between dorsal and outer prepuce(P=0.033), and there was also significant difference with ventral prepuce(P=0.047). But there was no significant difference between the two groups(P=0.326). There was no significant difference in the number of blood vessels between the dorsal and ventral prepuce(P=0.682). The number of superficial fascia vessels near the skin was significantly more than that of deep fascia(P=0.037). On the transverse plane, there are more branches of the superficial fascia to the urethral plate at the junction of the ventral external plate and the urethral plate.All 14 cases were followed up for 3 to 9 months with an average of(5.4±2.1)months.The penis was straight and satisfactory, urethral orifice was not cracked, urination was laborious and not forked, and there was no fistula.One patient with middle penile type developed postoperative infection and was controlled after anti-infective treatment.One patient with anterior penile type had slight urination after operation, but had no difficulty in urination. F6 metal urethral dilator was used to dilate for 2 months, and the urination was normal. Conclusion Urethral plate combined with crescent flap urethroplasty for hypospadias has a satisfactory appearance and fewer complications.It provides an optional operative method for the children who need no transection of urethra plate to straighten the penis, especially for the poor development of the penis and the insufficiency of the new urethral materials.The superficial fascia tissue on both sides of the urethral plate is an ideal material for the new urethra because of its abundant blood supply adjacent to the urethral plate and direct vascular connection. Key words: Urethral plate; Flap; Crescent; Hypospadias

Pharmaceutical study & preliminary analysis of Sheetala Parpati

The Parpati kalpana is a thin flake form of mercurial preparation which is unique in the field of Rasashastra. It is one among the Chaturvidha Rasayana and Agnisthayi Murchita Parada Bandha i.e., Pota Bandha of Parada. Sheetala parpati is an Ayurvedic medicine that comes under Parpati kalpana, used in the treatment of difficulty in urination, urinary calculi, dyspepsia, etc. There are two different references of Sheetala Parpati where the ingredients and method of preparation are different. In the present work an attempt has been made to prepare both the varieties of Sheetala parpati along with its analytical study. It is mainly indicated in Mutrakricchra (Dysurea) and other diseases like Amlapitta (Hyperacidity), Udarashoola (Abdominal pain), Ajeerna (Indigestion), Yakritvikara (Hepatic disorder), etc.
 Keywords: Parpati kalpana, Chaturvidha Rasayana, Sheetala Parpati, Mutrakricchra (Dysurea)

Abstract GS6-02: A randomized, double-blind, placebo-controlled trial of oxybutynin (Oxy) for hot flashes (HF): ACCRU study SC-1603

Abstract Background: HF occur in about 75% of midlife women and are associated with quality of life disruption and premature endocrine therapy discontinuation among breast cancer survivors. Estrogen therapy, effective for HF, is contraindicated in hormone receptor-positive breast cancer (BC). Previous studies have suggested that Oxy could be effective in managing HF. Methods: This randomized, placebo (P)-controlled trial enrolled women who had experienced HF ≥28 times per week over >30 days and of sufficient severity to seek treatment. Patients (pts) were randomized to receive oral Oxy at two doses: 2.5mg BID for 6 weeks (Oxy2.5), 2.5mg BID for a week with subsequent increase to 5mg BID (Oxy5), or matching P, in equal ratios. Baseline and monthly questionnaires were administered including a HF diary, the HF related daily interference scale (HFRDIS) and a symptom experience questionnaire. The primary endpoint was intra-patient change in weekly HF score and frequency from baseline to end of study compared using Kruskal-Wallis tests. Results: 150 pts were accrued between 2/23/2017-3/5/2018. 4 pts cancelled before starting treatment and were excluded from analyses. This interim report includes the first 104 pts for which at least one post-baseline evaluation was available. Baseline characteristics were well-balanced between the arms. Sixty-two percent were on tamoxifen or an aromatase inhibitor for the duration of the study. Pts on both Oxy doses had a significantly greater reduction in HF score and frequency compared to P. Pts on Oxy2.5 had a mean change in HF score of -10 (SD 7.4) vs -5.1 (SD 9.7) with P, p=0.003; and a mean change in average weekly number of HF of -4.6 (SD 3.1) vs -2.3 (SD 3.9), p=0.002. Pts on Oxy5 had a mean change in HF score of -16.2 (SD 5.1) vs -5.1 (SD 9.7) with P, p<0.001; and a mean change in average weekly number of HF of -7.0 (SD 4.0) vs -2.3 (SD 3.9), p<0.001. Repeated measures mixed models confirmed that, after adjusting for baseline values, both Oxy arms had significantly lower HF scores and frequency compared to P (p<0.001). HFRDIS revealed that pts in both Oxy arms experienced improvement in the following HF interference measures: work, social activities, leisure activities, sleep, relations, life enjoyment, and overall quality of life. Pts on Oxy5 also had improvement in HF interference with mood. Pts on Oxy2.5 experienced more stomach pain (p=0.031), diarrhea (p=0.007), nausea (p=0.04), headaches (0.032), episodes of confusion (0.012), dry mouth (p=0.003) and dry eyes (0.027) compared to P. Pts on Oxy5 experienced more constipation (0.004), dry mouth (0.001) and difficulty urinating (0.004) compared to P. There were no differences in study discontinuation due to adverse effects between either Oxy arm and P (Oxy2.5 vs P, p=0.653; Oxy5 vs P, p=0.483). Conclusions: Oxy is superior to P for management of HF. Oxy2.5 and 5 were both associated with significant improvements in HF scores and frequency as well as improvement in HF interference with several quality of life measures. While pts on Oxy experienced more side effects than pts on P, rates of discontinuation due to adverse events were low. This study was supported by the Breast Cancer Research Foundation. Citation Format: Leon-Ferre RA, Novotny PJ, Faubion SS, Ruddy KJ, Flora D, Dakhil C, Rowland KM, Graham ML, Le-Lindqwister N, Loprinzi CL. A randomized, double-blind, placebo-controlled trial of oxybutynin (Oxy) for hot flashes (HF): ACCRU study SC-1603 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS6-02.