Urinary Research Articles

Aerococcus urinae urinary tract infections: A case series.

Aerococcus urinae is an uncommon uropathogen that mainly affect the elderly with predisposing conditions. Aim of the present study was to investigate the clinical and microbiological characteristics of patients with urinary tract infections (UTIs) by A. urinae and determine the antimicrobial susceptibility patterns of the isolates, over the last 3 years at our institution. The medical records and microbiological data of patients from whom A. urinae was isolated from urine cultures at the university hospital of Heraklion, Crete, Greece, between 2020 and 2022, were retrospectively analyzed. The isolates were identified by the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Susceptibilities for antimicrobial agents were determined by the disk diffusion method and results were interpreted using the 2024 EUCAST breakpoints. The minimum inhibitory concentration for fosfomycin was evaluated by the MIC Test Strip method. A. urinae was encountered in cultures of 24 patients. The median patient's age was 72 years, and females slightly outnumbered males. Underlying diseases such as urologic disease, chronic lung disease, chronic kidney disease, heart disease, diabetes mellitus and dementia were found in 79.2% of patients. Two of the patients did not meet the criteria for a UTI. Susceptibility rates to penicillin, amoxicillin, meropenem, ciprofloxacin, levofloxacin, rifampicin, vancomycin, nitrofurantoin and fosfomycin were 100%, 100%, 100%, 83.3%, 79.2%, 100%, 100%, 95.8%, and 91.7%, respectively. Further surveillance studies and clinical trials are needed to confirm our data and to investigate the in vivo efficacy of the antimicrobial agents to treat UTIs by A. urinae.

Epidemiology, microbiological profile and susceptibility pattern of uropathogens from a tertiary care hospital in central India

Urinary tract infections (UTIs) are the second most common infection in the community, whereas in hospitals, they are the most common healthcare-associated infections. Monitoring factors like the most common causative organisms and their susceptibility pattern is essential for tailored management and practicing antimicrobial stewardship. This study was done to determine the epidemiology, microbiological profile, and susceptibility pattern of uropathogens to make better antibiotic policy.: This was a retrospective descriptive study done at the Department of Microbiology, Pt. JNM Medical College, Raipur, Chhattisgarh in which analysis of the culture isolates obtained from urine samples received between January 2022 to December 2022 was performed.: Out of 2893 urine samples, 784 (27.1%) showed significant growth on culture. Females were more affected than males with male to female ratio being 1:2.3. Most common causative organism found in our study was (41.9%) followed by species (23.9%), non-albicans species(11.09%) and (10.3%). isolates showed 100% susceptibility to fosfomycin; 93% for nitrofurantoin, and 93% for carbapenems. In the case of isolates of the susceptibility percentage for nitrofurantoin and carbapenems were 59% and 82% respectively. In isolates were 100% susceptible to Teicoplanin and Fosfomycin, 82% for Nitrofurantoin.: followed by species the most common uropathogen. Nitrofurantoin and Fosfomycin were the most effective antibiotics against uropathogens.

Real-world safety of dapagliflozin plus metformin in patients of type 2 diabetes mellitus in China: Post-hoc analysis of the DONATE study.

DONATE (NCT03156985) is a large-scale real-world study investigating the safety of dapagliflozin in Chinese type 2 diabetes mellitus (T2DM) patients. This post-hoc analysis aims to further evaluate the real-world safety of dapagliflozin plus metformin. Safety outcomes were assessed in patients receiving concomitant dapagliflozin and metformin, with or without other antidiabetics. The safety of dapagliflozin-based dual-therapies and dapagliflozin and metformin-based triple-therapies were also analysed. Among the 2,990 patients in DONATE, 2,165 (72.4 %) received concomitant metformin. Among these 2,165 patients, 780 (36.0 %) experienced ≥ 1 adverse event (AE), 129 (6.0 %) experienced serious AE (SAE), and 96 (4.4 %) experienced AE leading to dapagliflozin discontinuation. The most common AEs were upper respiratory tract infection (4.0 %), urinary tract infection (UTI, 2.1 %) and constipation (1.5 %). The most common AEs of special interest of dapagliflozin were UTI (2.3 %), genital tract infection (1.5 %) and hypoglycaemia (1.1 %). In the dapagliflozin and metformin dual-therapy subgroup, the incidences of AE, SAE and AE leading to dapagliflozin discontinuation were 26.7 %, 2.5 %, and 1.9 %, respectively, numerically lower than that of the total population and most other dual-therapy subgroups. These patients also had numerically improved metabolic outcomes than baseline. Dapagliflozin and metformin combination therapy is well-tolerated in real-world Chinese T2DM patients.

Increased Lower Urinary Tract Symptoms in Male Hyperthyroid Patients

Increased Lower Urinary Tract Symptoms in Male Hyperthyroid Patients

Integrating Pranic Healing for Sleep Improvement Among Subjects with Lower Urinary Tract Symptoms: A Randomized Controlled Trial

Integrating Pranic Healing for Sleep Improvement Among Subjects with Lower Urinary Tract Symptoms: A Randomized Controlled Trial

Pathogenic Bacteria Caused Urinary Tract Infections: A Review

The urinary system is one of the most vital organs susceptible to infection; especially bacterial ones. Urinary tract infections (UTIs) mean colonization of urinary tracts by pathogenic microorganisms leading to inflammation of urinary system. In this study, we review the basic concepts of the most important pathogenic microbes infected this system. Enterobacteriaceae is a large group of Gram-negative bacillus bacteria that are naturally found as commensals in the intestine and are pathogenic and opportunistic, exploiting any opportunity to cause many infections, and they are the main cause of urinary tract infections. Uropathogenic E. coli strain causes approximately 90% of UTIs. Besides, Klebsiella pneumoniae represents most important pathogenic bacteria causing diseases, especially UTIs in children. It was found, that severity of this infection mainly related with virulence of causative bacteria as well as the host’s immune system.

Cefazolin shifts the kidney microbiota to promote a lithogenic environment

Clinical studies of the urinary tract microbiome, termed urobiome, suggest a direct, antibiotic-dependent, impact of the urobiome on kidney physiology. However, evidence for kidney bacteria comes from indirect sources or infected tissue. Further, it is unclear how antibiotics impact kidney bacteria. Here we show direct evidence for the presence of bacteria in the kidneys, with microniches in nephrons. In murine kidneys, administration of cefazolin, a commonly used perioperative antibiotic, led to a loss of uroprotective Lactobacillus spp. and proliferation of Enterobacteriaceae (which includes many known uropathogens). This effect was dependent on treatment duration, with recovery post treatment. Uroprotective L. crispatus and a strain of stone-associated E. coli differentially influenced calcium oxalate (CaOx) crystallization through the incorporation of CaOx inhibitors or promoters, respectively. In humans, microbial signatures were identified in the kidney, with unique niches between the glomeruli and tubules, established through RNA sequencing analysis and direct imaging of two independent populations. Collectively, findings support the hypothesis that the kidneys harbor a stable and antibiotic-responsive microbiota that can influence CaOx lithogenesis. The presence of unique, age-dependent microbial signatures in the glomeruli and tubuli carry implications for non-infectious kidney diseases.

Rare STAT3 haplotypes cause a predisposition to develop congenital anomalies of the kidney and urinary tract disorder

Rare STAT3 haplotypes cause a predisposition to develop congenital anomalies of the kidney and urinary tract disorder

Record of Renicola sloanei Wright, 1954 (Plagiorchiida: Renicolidae) in the Atlantic puffin Fratercula arctica (Linnaeus, 1758) arrived at the Canary Islands (Spain).

In the winter of 2022-2023, hundreds of the Atlantic puffins (Fratercula arctica) appeared dead in the coast of the Canary Islands, a rare event considering their cold-living habits, normally occupying the North Atlantic Ocean. In this work, investigation about the parasites present in the Atlantic puffins found in the biggest islands of the Archipelago was carried out from a population portion. Necropsies of 39 birds were made and, during the examination of the urinary tracts, helminths were found. Morphoanatomical analysis under microscope allowed to identify them into Renicola genus with high similarity to Renicola sloanei. After that, DNA was extracted and NADH dehydrogenase subunit 1 gene were amplificated by a polymerase chain reaction method followed by sequencing and phylogenetic analysis. The molecular results demonstrated that in fact R. sloanei was the helminth parasite present in the urinary tracts of the Atlantic puffins found in the Canary Islands.

Decreased urinary excretion of norepinephrine and dopamine in autonomic synucleinopathies.

Autonomic synucleinopathies feature autonomic failure and intracellular deposition of the protein alpha-synuclein. Three such conditions are the Lewy body diseases (LBDs) Parkinson's disease (PD) and pure autonomic failure (PAF) and the non-LBD synucleinopathy multiple system atrophy (MSA). These diseases all entail catecholaminergic abnormalities in the brain, sympathetically innervated organs, or both; however, little is known about renal catecholaminergic functions in autonomic synucleinopathies. We measured urinary excretion rates of the sympathetic neurotransmitter norepinephrine, the hormone epinephrine, the autocrine-paracrine substance dopamine, the catecholamine precursor 3,4-dihydroxyphenylalanine (DOPA), 3,4-dihydroxyphenylglycol (DHPG, the main neuronal metabolite of norepinephrine), and 3,4-dihydroxyphenylacetic acid (DOPAC, a major dopamine metabolite), in PD, PAF, and MSA groups and controls. Data were reviewed from all research participants who had urine collections (usually 3.5 h) at the National Institutes of Health (NIH) Clinical Center from 1995 to 2024. The control cohort had neither autonomic failure nor a movement disorder. Norepinephrine excretion rates were decreased compared with controls in PD (p = 0.0001), PAF (p < 0.0001), and MSA (p < 0.0001). Dopamine excretion was also decreased in the three groups (PD: p = 0.0136, PAF: p = 0.0027, MSA: p = 0.0344). DHPG excretion was decreased in PD (p = 0.0004) and PAF (p = 0.0004) but not in MSA. DOPA and epinephrine excretion did not differ among the study groups. Autonomic synucleinopathies involve decreased urinary excretion rates of norepinephrine and dopamine. Since virtually all ofurinary dopamine in humans is derived from circulating DOPA, the low rates of urinary norepinephrine and dopamine excretion may reflect dysfunctions in the renal sympathetic noradrenergic system, the DOPA-dopamine autocrine-paracrine system, or both systems.

Comparison of suction technique and non-suction technique in retrograde intrarenal stone surgery: a systematic review and meta-analysis.

To evaluate the clinical efficacy of retrograde intrarenal stone surgery (RIRS) using the vacuum suction technique for the treatment of upper urinary calculi. A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Sino Med, CNKI, WANFANG DATA, and Cochrane. We included studies comparing vacuum suction RIRS with non-vacuum RIRS. Following the PRISMA guidelines, we performed a meta-analysis of the selected studies. Inclusion criteria were randomized controlled trials (RCTs), case-control studies, and retrospective studies evaluating the efficacy of these techniques. Key outcomes analyzed included operative time, hospitalization duration, stone-free rates, and complication rates. Statistical analyses were conducted using mean differences (MD) for continuous variables and odds ratios (OR) for dichotomous outcomes, with corresponding 95% confidence intervals (CI). Sixteen studies (6 RCTs, 1 case-control study, and 9 retrospective studies) involving a total of 2029 patients were included. Meta-analysis revealed that the vacuum suction technique significantly reduced operative time (MD = -14.45min, 95% CI [-18.45; -10.44], P < 0.00001) and hospital stay (MD = -0.54days, 95% CI [-0.80; -0.28], P < 0.00001). In addition, patients in the vacuum suction group had a higher stone-free rate (OR = 3.57, 95% CI [2.57; 4.95], P < 0.00001) and lower complication rates, particularly in reducing postoperative fever. The application of the vacuum suction technique in RIRS significantly improves clinical outcomes by reducing operative time and hospitalization duration, enhancing stone-free rates, and lowering postoperative complication rates. This technique demonstrates a clear clinical advantage over non-vacuum RIRS and should be considered a preferred option for the management of upper urinary tract stones.

Nitrofurantoin Induced Lung Disease

Nitrofurantoin is a synthetic nitrofuran antimicrobial commonly used for the treatment and prevention of recurrent urinary tract infections (UTIs). Although rare nitrofurantoin can cause acute and chronic lung diseases. We report the case of an 81-year-old woman diagnosed with interstitial lung disease (ILD) due to long-term use of Nitrofurantoin for UTI prophylaxis. Despite widespread lung parenchymal changes in the form of fibrosis and ground glass opacities, she responded very well to corticosteroids. This case report highlights the importance of early recognition and favorable response to corticosteroids in nitrofurantoin-induced ILD. Keywords: Nitrofurantoin, Lung Diseases, Interstitial Fibrosis, Corticosteroid.

Sexual dysfunction after Rezum therapy for benign prostatic hyperplasia: A scoping review for the current insights and findings

AbstractBenign prostatic hyperplasia (BPH) is a common condition among aging men, often leading to lower urinary tract symptoms (LUTS) of varying severity. Both medical and surgical treatments for BPH can negatively impact sexual function, affecting patients' overall quality of life. This has highlighted the need for minimally invasive interventions that minimize sexual side effects. Rezum, a water vapor therapy, has gained popularity in managing BPH and LUTS due to its proposed potential to preserve sexual function. This scoping review examines the impact of Rezum therapy on sexual function in patients treated for BPH. The review was conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews. A comprehensive search was performed using the PubMed and Scopus databases up to August 2024. Articles were included if they involved patients treated with Rezum for BPH and reported the effect of Rezum on sexual function using validated scoring tools. A total of 15 studies encompassing 2,425 patients, met the inclusion criteria. Erectile function was assessed in all studies using the International Index of Erectile Function (IIEF) scores. Of these, seven studies reported no significant changes in erectile function scores, six demonstrated improvements, and two reported a significant decline. Ejaculatory function was evaluated using the Male Sexual Health Questionnaire (MSHQ). The MSHQ‐Bother score was reported in seven studies, with three indicating improvement and none reporting deterioration. The MSHQ‐Function score was reported in eight studies, with only one study reporting a decline, while the remaining studies found no significant changes. In conclusion, Rezum therapy for managing BPH shows favorable outcomes for sexual function or, at the very least, does not negatively impact it. These findings can guide patient counseling, especially for those seeking to preserve ejaculation. Further research is needed to compare Rezum with other treatment options regarding sexual function.

Diagnostic and prognostic genomic aberrations in upper tract urothelial carcinoma can be identified in focal barbotage samples.

To investigate whether genetic analysis of focal barbotage samples obtained at ureterorenoscopy (URS) is possible, and to identify genetic aberrations that might add prognostic information. This prospective study included barbotage samples from 42 patients with upper urinary tract urothelial carcinoma (UTUC) confirmed at URS. At URS, focal barbotage specimens were collected for cytology and for gene sequencing. Tumour grades were determined from cytology and/or biopsy, or from radical nephroureterectomy samples. Next-generation sequencing using a 385-gene panel was performed and single nucleotide variants (SNVs), deletions/insertions (indels) and copy number aberrations (CNAs) were identified. Manual filtering of the SNVs/indels was performed to identify possible pathogenic mutations. Of the 42 samples, two failed quality control, therefore, 40 focal barbotage samples were sequenced. We identified known and suspected pathogenic mutations and other genomic aberrations in 36 samples. The most common variants were in TERT (78%), FGFR3 (50%), KMT2D (42%), KDM6A (42%), ARID1A (39%), TP53 (19%) and deletion of 9q (50%). Known pathogenic mutations in FGFR3 were common in grade 1 and 2 tumours, but not present in any grade 3 tumour. No patients with an FGFR3 mutation died during follow-up. TP53 variants or deletions, as well as amplifications of MDM2, were only present in high-grade (HG) tumours or low-grade (LG) tumours in patients who had metastasis/died from urinary tract carcinoma. CNAs were detected in 36/40 barbotage samples, 91% of the HG samples and 69% of the LG samples, including those from all five patients with LG tumours with metastasis or who died from urinary tract cancer. Focal barbotage samples enable identification of gene mutations and other genetic aberrations that may add important prognostic information to histopathology and cytology. Refined prognostication of UTUC patients already at diagnosis can guide treatment decisions and follow-up programmes.

Efficacy and Safety of Two Different Approaches in the Drainage of the Upper Urinary Tract in "Acute Obstructive Uropathy": A Critical Evaluation.

Aim: To compare the results of retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) procedures for decompression in patients with acute obstructive pyelonephritis. Patients and Methods: Medical records of patients undergoing PCN or RUS for emergency urinary diversion because of obstructive pyelonephritis were evaluated retrospectively. Patients with urinary tract obstruction and concurrent fever (≥38°C), pyuria, and costovertebral angle tenderness were included and divided into two groups based on the type of emergency urinary drainage applied (PCN in Group 1) and (RUS in Group 2). Apart from the demographic data and Charlson Comorbidity Index, laboratory and radiologic examination outcomes were well evaluated. Results: A total of 155 patients including 73 patients (47.1%) undergoing PCN (Group 1) and 82 patients (52.9%) undergoing RUS (Group 2). Although no significant difference was found regarding the demographic characteristics, the operation time, as well as fluoroscopy time, was significantly shorter in Group 1 cases when compared with those in Group 2 (p < 0.0001). The success rate was similar between the two groups, and there was also a significant difference regarding the complication rates in both groups of cases (5.5% vs 7.3%). Conclusions: Our findings showed that despite similar efficacy and success rates noted between PCN and RUS applications in the emergency drainage of cases presenting with obstructive pyelonephritis, PCN application was found to be advantageous because of shorter operation and fluoroscopy durations. More importantly, this approach was associated with a significantly less need for intensive care during the postoperative period.

Congenital Anterior Urethral Diverticulum: A Case Report

Congenital anomalies of lower urinary tract are most common anomalies found in children, but congenital anterior urethral diverticulum is a very rare cause. Here we present 11 month old male child presented with soft cystic swelling in the ventral side of the penile shaft and underwent open diverticulectomy.

Role of Tamsulosin and Solifenacin to Reduce Double J Stent Related Symptoms After Uncomplicated Ureteroscopic Lithotripsy

Introduction: Endoscopic urological surgeries are safe procedures with further reduction in morbidity due to double J stents. Stents usually give rise to lower urinary tract symptoms and various drugs have been prescribed singly drug or in combination to ameliorate the symptoms. Since double J stenting of the ureter is one of the most common procedures in our department, we attempted to compare the efficacy of the anti-muscarinic drug Solifenacin over alpha-blocker Tamsulosin. Materials and methods: A prospective study was done where 50 consecutive patients who underwent double J stenting following ureteroscopic lithotripsy were randomized and given 5 mg Solifenacin or 0.4 mg Tamsulosin. Lower urinary tract symptoms were assessed at end of first and second week. The results were analyzed. Results: Fifty consecutive patients who underwent ureteroscopic lithotripsy were enrolled in the study. 25 of them were randomly prescribed Solifenacin and 25 were prescribed Tamsulosin based on computer generated randomization. The IPSS score was higher in the Solifenacin group, compared to the Tamsulosin group in both the first and second weeks, which was significantly higher in the first week. The reduction of symptoms within the first and second week in both groups was clinically significant, Solifenacin group being p &lt;0.0001 and Tamsulosin group being 0.0004. Conclusions: Lower urinary tract symptoms are common and quite bothersome following DJ stent insertion. The symptoms can be ameliorated with the use of alpha blockers and anti-muscarinic drugs.

The Analysis Study of Safety and Outcome of Ureteroscopy During Pregnancy: A Comprehensive Systematic Review

Background: Symptomatic urolithiasis in pregnancy can result in significant morbidity, causing conditions such as renal colic, urinary tract infections, and ureteral obstruction. This systematic review aim to analyze the safety and outcomes of uretrhoscopy for pregnant women. Methods: The study followed PRISMA 2020 guidelines, reviewing English-language publications from 2014 to 2024. Editorials, duplicate reviews from the same journal, and papers lacking a DOI were excluded. The literature search was conducted using PubMed, SagePub, SpringerLink, and Google Scholar. Result: A total of 2,172 articles were initially identified through online databases (PubMed, SagePub, SpringerLink, and Google Scholar). After three rounds of screening, eight relevant studies were selected for full-text analysis. Conclusion: Ureteroscopy is a safe, effective, and cost-efficient treatment for ureteral calculi during pregnancy. Early intervention minimizes complications, and URS remains a successful option for managing obstructive uropathy. Future research should optimize protocols and assess long-term outcomes for improved care.

Effect of ICG fluorescence-assisted new nerve-sparing of robot-assisted radical prostatectomy on lower urinary tract symptoms.

The aim of the present study was to determine the efficacy and safety of our newly developed ICG-assisted nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) through subjective and objective data. This study included 43 NS RARP patients, divided into ICG (23 patients) and non-ICG (20 patients) groups. Immunohistochemical staining with nNOS antibodies was conducted on specimens of resected prostate from the base, middle, and apex to count nNOS-positive cells. Fewer nNOS-positive cells suggested higher quality for the NS procedure. Postoperative erectile function, urinary incontinence, lower urinary tract symptoms (LUTS) as evaluated by the International Prostate Symptom Score (IPSS), and lower urinary tract function were compared between groups, operative time, and adverse events. Only the number of n-NOS-positive cells at the base differed significantly between the ICG group (15.0 ± 6.9) and the non-ICG group (26.9 ± 21.4, p = 0.02). Regarding LUTS, in the ICG group, significant improvement was only seen in postoperative IPSS scores (13.6 ± 4.9 to 8.7 ± 5.0, p = 0.02). No significant differences in the postoperative erectile function, urinary incontinence, and lower urinary tract function were seen between groups. In addition, significant differences in operative time and rate of adverse events were not observed between groups. Our innovative approach enhances the visualization of prostatic boundaries, suggesting potential for reliable and straightforward NS procedures, with a significant improvement in LUTS, without evidence of prolonged operative time or an increased frequency of adverse events.

Is Intravesical Gentamicin the New Gold Standard to Manage Refractory Urinary Tract Infections?-Experience From a Dedicated Multidisciplinary Complex UTI Clinic.

To assess the effectiveness of intravesical gentamicin in managing recurrent urinary tract infections (rUTIs) refractory to first- and second-line treatments. This single-centre prospective cohort study included 41 patients treated with intravesical gentamicin over a 24-month period from 2021 to 2023. A multidisciplinary team comprising functional urologists, microbiologists, and specialist nurses was involved in the decision-making process and in designing the treatment protocol. Patients self-administered gentamicin instillations into the bladder according to a 6-month instillation schedule. Patients were followed up during and after the treatment period to assess the treatment response. A total of 41 patients with rUTIs were treated using the 6-month intravesical gentamicin regimen. Of these, 10 were male and 31 were female, with a mean age of 53 years. E. coli was isolated from urine cultures in 19 patients (46%), while 19 patients had multiple organisms. Serum gentamicin levels were undetectable in all patients 1 week after treatment initiation. The mean follow-up period was 15 months with minimum follow up of 6 months for all patients. Following gentamicin administration, hospital admission rates due to urosepsis decreased from 46% to 5%, and the prevalence of multidrug-resistant organisms in urine cultures decreased from 44% to 10%. A significant reduction in UTI frequency was observed in 80.5% of patients, with 71% reporting good to excellent Patient Global Impression of Improvement (PGI-I) scores. Additionally, 76% of patients reported a significant improvement in Quality of Life (QoL). In our cohort of patients with recurrent and refractory UTIs, intravesical gentamicin instillations has shown to be both safe and effective, leading to notable improvements in patients' symptoms and QoL.