Urological Disorders Research Articles

Applications of neural networks in urology: a systematic review.

Over the last decade, major advancements in artificial intelligence technology have emerged and revolutionized the extent to which physicians are able to personalize treatment modalities and care for their patients. Artificial intelligence technology aimed at mimicking/simulating human mental processes, such as deep learning artificial neural networks (ANNs), are composed of a collection of individual units known as 'artificial neurons'. These 'neurons', when arranged and interconnected in complex architectural layers, are capable of analyzing the most complex patterns. The aim of this systematic review is to give a comprehensive summary of the contemporary applications of deep learning ANNs in urological medicine. Fifty-five articles were included in this systematic review and each article was assigned an 'intermediate' score based on its overall quality. Of these 55 articles, nine studies were prospective, but no nonrandomized control trials were identified. In urological medicine, the application of novel artificial intelligence technologies, particularly ANNs, have been considered to be a promising step in improving physicians' diagnostic capabilities, especially with regards to predicting the aggressiveness and recurrence of various disorders. For benign urological disorders, for example, the use of highly predictive and reliable algorithms could be helpful for the improving diagnoses of male infertility, urinary tract infections, and pediatric malformations. In addition, articles with anecdotal experiences shed light on the potential of artificial intelligence-assisted surgeries, such as with the aid of virtual reality or augmented reality.

Management of major vascular injury in laparoscopic urology

ObjectiveDuring the past three decades, laparoscopy has played a significant role in the management of urological disorders. This study aims to standardize the management of major vascular injury, which is a life-threatening complication in the laparoscopic urological procedures. MethodsA total of 8210 patients with the urological disorder, who underwent laparoscopic surgery at Sir Run Run Shaw Hospital from January 2000 to December 2018, were included in this retrospective study. Patients’ data of the laparoscopic major vascular injury were collected and analyzed, and the basic principles of the procedure were summarized. ResultsA total of 15 (0.18%) cases of major vascular injury were found among the 8210 patients, and 2 of them were converted to open surgery. Although the type of laparoscopic surgery, causes, and management of major vascular injury among the patients were diverse, the main management strategies of major vascular injury in laparoscopic surgery were to keep the vision clear, control bleeding rapidly by clamping and compression, make full preparation for possibly needed liquid resuscitation, and try best to repair under laparoscope. If necessary, converse to open surgery. ConclusionAlthough the reported incidence of major vascular injury in laparoscopic urological surgery is extremely low, such injury can result in high morbidity and mortality. It is important to rapidly identify the cause and strictly follow the standardized management for better outcomes.

The Microbiome of Catheter Collected Urine in Males with Bladder Cancer According to Disease Stage

The dogma that urine is sterile has been overturned and dysbiosis of the urinary microbiome has been linked to many urological disorders. We tested the hypothesis that the urinary microbial composition may be different between men with or without bladder cancer in catheter collected urines, bladder washouts and midstream voided urines, and may be dependent on tumor staging. Liquid samples were collected from male patients with bladder cancer, and sex and age matched nonneoplastic controls. Total DNA was extracted and processed for 16S rRNA gene sequencing. Bioinformatic analysis for microbial classification was performed to assess diversity and variations. The urinary microbiome associated with catheter collected urine samples of patients with bladder cancer was characterized by a significantly increased abundance of Veillonella (p=0.04) and Corynebacterium (p=0.03), and decreased Ruminococcus (p=0.03) compared to controls, with differences exacerbating with disease progression. Compared to catheterized urines, bladder cancer washouts showed the specific increase of some taxa, like Burkholderiaceae (p=0.014), whereas midstream urines were enriched in Streptococcus (p <0.0001), Enterococcus (p <0.0001), Corynebacterium (p=0.038) and Fusobacterium (p <0.0001). The bladder is colonized by endogenous bacteria and microbial modifications characterize the microbiome of patients with bladder cancer. Different microbial compositions can be characterized by changing sampling strategy. These results pave the way for exploring new diagnostic and therapeutic options based on the manipulation of the bacterial community.

Bibliometric Analysis of the Bladder Cancer Publications Between 1975-2018

Background: Bladder cancer is one of the major health problems studied over the years. Emerging technologies on follow-up and treatment of bladder cancer increased scientific literature worldwide. Despite this, there is limited data about the bibliometric analysis of bladder cancer. Materials and Methods: The bibliometric analysis of bladder cancer publications between 1975-2018 was performed by using the Thomson Reuters Web of Science database. The VOSviewer software tool was used for arranging and setting bibliometric networks.Results: The United States of America ranked first in this field with 7963 publications and 28.3% of the world generation, followed by the Peoples Republic of China and Germany. The University of Texas System is the leading institute in published documents with 1081 papers and 3.8% of the total literature. 15.9% of the papers were printed in The Journal of Urology with 4483 manuscripts, followed by European Urology (n=867, 3.0%) and Urology (n=810, 2.8%).Conclusions: There are relatively few articles on bibliometric analysis of urologic disorders and bladder cancer. Advanced evaluation parameters have to be defined for a more confident assessment of scientific work. Bibliometric analyses can guide young clinicians in investigating new studies.

Hospitalization Rates and Comorbidities in Patients with Progressive Supranuclear Palsy in Germany from 2010 to 2017.

Progressive supranuclear palsy (PSP) belongs to the disease spectrum of Parkinsonian syndromes. Due to the chronic and progressive neurodegenerative course of the disease, PSP patients often have to be hospitalized to undergo diagnostic and therapeutic measures. The dynamics and characteristics of PSP inpatient treatment in Germany have not been investigated thus far. The current study analyzed trends of inpatient treatment in Germany for the years 2010–2017 based on the German DRG statistics (“diagnostic-related groups”) in the category G23.- (other degenerative diseases of the basal ganglia) and with special focus on PSP (G23.1). Inpatient case numbers of the G23.- category comprised a total of 21,196 patients from 2010–2017, whereas the PSP subcategory (G23.1) amounted to 10,663 cases. In the analyzed time period, PSP patient numbers constantly increased from 963 in 2010 to 1780 in 2017 with yearly growth rates of up to 20%. Similar trends were observed for other Parkinsonian syndromes such as multiple system atrophy (MSA). Differentiating PSP inpatients by gender demonstrated a higher proportion of males (55–60%) in comparison to female patients for the entire observation period. The average age of hospitalized PSP patients over these years was between 72.3 and 73.4 years without relevant differences for gender. The most common comorbidities consisted of cardiovascular, neurological, muscular and urological disorders. In summary, the analysis demonstrates that PSP patients are increasingly hospitalized in Germany and the current concepts of stationary care have to differentiate standard practices for Parkinson’s disease (PD) to also address the needs of patients with PSP and other Parkinsonian syndromes.

Clinical trials of homeopathy in urological disorders: a systematic review.

Homeopathy remains one of the most sought after therapies for urological disorders. The aim of this paper was to systematically review the available clinical researches of homeopathy in the said conditions. Relevant trials published between Jan 1, 1981 and Dec 31, 2016 (with further extension up to Dec 31, 2017) was identified through a comprehensive search. Internal validity of the randomized trials and observational studies was assessed by The Cochrane Collaboration's tool andmethodological index for non-randomized studies (MINORS) criteria respectively, homeopathic model validity by Mathie's six judgmental domains, and quality of homeopathic individualization by Saha's criteria. Four controlled (three randomized and one sequentially allocated controlled trial) trials were reviewed and 14 observational studies alongside -all demonstrated positive effect of homeopathy. Major focus areas were benign prostatic hypertrophy and renal stones. One of the four controlled trials had 'adequate' model validity, but suffered from 'high' risk of bias. None of the non-randomized studies was tagged as 'ideal' as all of those underperformed in the MINORS rating. Nine observational studies had 'adequate' model validity and quality criteria of individualization. Proof supporting individualized homeopathy from the controlled trials remained promising, still inconclusive. Although observational studies appeared to produce encouraging effects, lack of adequate quality data from randomized trials hindered to arrive at any conclusion regarding the efficacy or effectiveness of homeopathy in urological disorders. The findings from the RCTs remained scarce, underpowered and heterogeneous, had low reliability overall due to high or uncertain risk of bias and sub-standard model validity. Well-designed trials are warranted with improved methodological robustness. None; Registration web-link: https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018081624&ID=CRD42018081624.

Molecular epidemiology and genome analysis of feline morbillivirus in household and shelter cats in Thailand

BackgroundFeline morbillivirus (FeMV) has been discovered in domestic cats associated with tubulointerstitial nephritis, but FeMV is also detected in healthy cats. This research aimed to identify and characterize the FeMV strains detected in a Thai cat population.ResultsTwo-hundred and ninety-two samples (131 urine and 161 blood) derived from 261 cats (61 sheltered and 200 household cats) were included for investigating the FeMV prevalence using real-time reverse transcription PCR. The overall prevalence of FeMV detection was 11.9% (31/261) among both samples, which accounted for 14.5% (19/131) and 7.5% (12/161) of the urine and blood samples, respectively. Among the FeMV-PCR positive cats, the FeMV-detected prevalence was insignificantly associated with healthy cats (58.1%; 18/31) or urologic cats (41.9%; 13/31). Full-length genome analysis of these FeMV-Thai strains revealed that their genomes clustered together in the FeMV-1A clade with up to 98.5% nucleotide identity. Selective pressure analysis showed that overall FeMV-1 has undergone negative selection, while positive selection sites were more frequently observed in the phosphoprotein gene.ConclusionsThe detected FeMV infections in the Thai cat population were not correlated with urologic disorders, although the virus was more detectable in urine samples. The genetic patterns among the FeMV-1 Thai strains were more consistent. A large-scale study of FeMV in Thai cat samples is needed for further elucidation.

Effective Reconstruction of Functional Urethra Promoted With ICG-001 Delivery Using Core-Shell Collagen/Poly(Llactide-co-caprolactone) [P(LLA-CL)] Nanoyarn-Based Scaffold: A Study in Dog Model.

Hypospadias and urethral stricture are common urological diseases which seriously affect voiding function and life quality of the patients, yet current clinical treatments often result in unsatisfactory clinical outcome with frequent complications. In vitro experiments confirmed that ICG-001 (a well-established Wnt signaling inhibitor) could effectively suppress fibroblast proliferation and fibrotic protein expression. In this study, we applied a novel drug-delivering nanoyarn scaffold in urethroplasty in dog model, which continuously delivers ICG-001 during tissue reconstruction, and could effectively promote urethral recovery and resume fully functional urethra within 12 weeks. Such attempts are essential to the development of regenerative medicine for urological disorders and for broader clinical applications in human patients.

Managing Urological Disorders in Multiple Sclerosis Patients: A Review of Available and Emerging Therapies.

Multiple sclerosis (MS) is a progressive neurological autoimmune disease with a diverse range of urological symptomatology, and most MS patients experience 1 or more moderate to severe urinary symptoms, as well as bladder and/or sexual disorders. Urologists play the director’s role in evaluating and treating these patients. Therefore, identifying the proper evaluation tools and the most suitable therapeutic options for specific patients requires a thorough understanding of this disease process.

Potential of Mirabegron and its Extended-release Formulations for the Treatment of Overactive Bladder Syndrome.

Overactive bladder syndrome is a broadly occurring urological disorder with a distressing impact on the quality of life. The commonly used antimuscarinic drugs show poor patient compliance because of unsatisfactory potency, tolerability and high occurrence of adverse effects such as dry mouth, blurred vision, constipation, dizziness etc. Mirabegron is the first approved β3-adrenoreceptor agonist, used as mono or in combination therapies for overactive bladder syndrome. The present review provides an insight into the mechanism, pharmacokinetics, toxicokinetics, clinical trials and the development of various conventional and modified-release dosage forms of mirabegron for the treatment of overactive bladder syndrome. The clinical trials of phase II and phase III of mirabegron demonstrated symptomatic relief from the overactive bladder without disturbing the micturition cycle. To date, mirabegron showed promising results for safety, tolerability and efficacy in patients with overactive bladder syndrome. The modified-release tablet dosage form of mirabegron appear to be a proficient and suitable replacement for antimuscarinics and revealed the tremendous potential to overcome the adverse effects of conventional antimuscarinic drugs like Oxybutyline chloride ER, Detrol LA, VESIcare, etc. Conclusion: Mirabegron shows a distinct mode of action, i.e., targeting β3-adrenoreceptors and improving bladder storage without altering void contractions. The limited side effects, high safety, efficacy and tolerability of mirabegron present an adequate substitute to antimuscarinics. However, long-term analysis and clinical studies are prerequisites for assessing the safety, tolerability and efficacy profile of mirabegron.

Obstructive Sleep Apnea Syndrome as a Potential Cause of Nocturia in Younger Adults

To investigate the impact of age on the relationship between obstructive sleep apnea syndrome (OSAS), nocturia, and other lower urinary tract symptoms (LUTSs). This was a secondary analysis study based on data derived from a previously conducted prospective observational cohort study on OSAS and nocturia. We analyzed 90 subjects who were suspected of having OSAS. Prior to polysomnography, we assessed International Prostate Symptom Score-Quality of Life scores, Overactive Bladder Symptom Scores, and International Consultation on Incontinence Modular Questionnaire-Nocturia Quality of Life scores to evaluate LUTSs. Nocturnal urine volume, night-time frequency, and night-time urine electrolyte content were measured during polysomnography. Patients were divided into groups according to age and OSAS severity determined using apnea-hypopnea index (AHI) scores. Young patients were those aged <65 years and elderly patients, ≥65 years. A multiple linear regression with multiple imputations was performed to examine the association of night-time frequency with demographic, polysomnographic, and clinical characteristics. In young patients, night-time frequency was significantly associated with nocturnal urine volume, AHI score, and total IPSS. However, night-time frequency in elderly subjects was not associated with demographic and polysomnographic characteristics. In order to compare the severity of OSAS, night-time frequency and urinary sodium content significantly increased only in young patients (P=.007 and .004, respectively). OSAS is a strong candidate of causative factor for nocturia in younger individuals. When a younger patient complains nocturia without any urological disorders, OSAS should be kept in mind as a potential cause of nocturia.

Medications and Botulinum Toxin for Overactive Bladder

Previously published literature has estimated that approximately 16.5% of American adults have OAB, and up to 37% of OAB patients have concomitant urinary incontinence (OAB-wet). In fact, OAB is one the most common urologic disorders, accounting for more than 2 million physician office visits in the United States (2007). Nonneurogenic OAB is a symptom complex, which is defined by the International Continence Society standardization committee as urgency, with or without urgency incontinence, usually with frequency and nocturia, in the absence of proven infection or other obvious pathology. Urgency with at least one other symptom is essential to diagnose OAB and is the cornerstone component of OAB. To date, there is a paucity of validated instruments to define urinary urgency, and therefore, the diagnosis of OAB is based on patient symptomatology. Diagnosis does not rely on urodynamic findings or characteristics and therefore a thorough history and physical examination are essential. Treatment for this nonsurgical condition is therefore aimed toward symptom control. This review provides the reader with a better understanding of the voiding cycle and available medical treatment options for nonneurogenic overactive bladder (OAB). This review contains 11 figures, 7 tables, and 90 references. Key Words: anticholinergic, β3 agonist, botulinum toxin, chemodenervation, cialis, intradetrusor onabotulinumtoxinA, micturation cycle, mirabegron, overactive bladder, phosphodiesterase type 5 inhibitors, urinary retention

Medications and Botulinum Toxin for Overactive Bladder

Previously published literature has estimated that approximately 16.5% of American adults have OAB, and up to 37% of OAB patients have concomitant urinary incontinence (OAB-wet). In fact, OAB is one the most common urologic disorders, accounting for more than 2 million physician office visits in the United States (2007). Nonneurogenic OAB is a symptom complex, which is defined by the International Continence Society standardization committee as urgency, with or without urgency incontinence, usually with frequency and nocturia, in the absence of proven infection or other obvious pathology. Urgency with at least one other symptom is essential to diagnose OAB and is the cornerstone component of OAB. To date, there is a paucity of validated instruments to define urinary urgency, and therefore, the diagnosis of OAB is based on patient symptomatology. Diagnosis does not rely on urodynamic findings or characteristics and therefore a thorough history and physical examination are essential. Treatment for this nonsurgical condition is therefore aimed toward symptom control. This review provides the reader with a better understanding of the voiding cycle and available medical treatment options for nonneurogenic overactive bladder (OAB). This review contains 11 figures, 7 tables, and 90 references. Key Words: anticholinergic, β3 agonist, botulinum toxin, chemodenervation, cialis, intradetrusor onabotulinumtoxinA, micturation cycle, mirabegron, overactive bladder, phosphodiesterase type 5 inhibitors, urinary retention

The necessity of voiding cystourethrogram for the evaluation of recipient candidates in adult renal transplantation

Objective . While international guidelines necessitate Voiding Cystourethrogram (VCUG) for pediatric patients, it is unnecessary for the evaluation of adult patients without urological disorders as renal transplant candidates. The objective of this study was to evaluate the results of adult candidates who underwent VCUG before transplantation and to demonstrate the necessity for this imaging. Methods . A retrospective study of the data of 1265 adult candidates who underwent VCUG before transplantation at our center, was undertaken. VUR, the presence of Postvoiding residual urine (PVR) (>100 ml), Low bladder capacity (LBC) (<100 ml), and urethral pathologies were evaluated with VCUG. Results . The mean age was 42.3 ± 1.3. The mean dialysis period was 27.8 ± 4.2 months. According to the VCUG results, 19.2% of the patients had pathological findings. On the other hand, the rate of urological disorders was only 5.1%, according to end-stage renal disease (ESRD) etiologies. VCUG outcomes indicated bilateral high-grade reflux in native kidneys in 4.4% (n = 56) of the candidates, unilateral high-grade reflux in 4.1% (n = 52), bilateral low grade reflux in 2.1% (n = 26), unilateral low-grade reflux in 2.4% (n = 30), and reflux in rejected transplanted kidney in 2.3% (n = 29). In addition, significant LBC was noted in 4.8% (n = 61), significant PVR in 1.1% (n = 14), and urethral stricture in 0.5% (n = 6) of the candidates. Conclusion . VCUG should be considered as a part of routine evaluation in adult renal transplant recipient candidates as well as in pediatric candidates, even if their ESRD etiologies are not due to urological disorders.

MP51-05 URINARY MICROBIOTA IN PATIENTS WITH UROLOGIC MALIGNANCIES

INTRODUCTION AND OBJECTIVE:Dysbiosis of the urinary microbiome has also been identified as the cause of various urological disorders, such as urgency urinary incontinence, overactive bladder and pr...

MP06-05 PUNICALAGIN MITIGATES TESTOTERONE PROPIONATE (TP)-INDUCED BENIGN PROSTATIC HYPERPLASIA (BPH) IN CASTRATED RATS VIA OXIDO-INFLAMMATORY AND APOPTOTIC MECHANISM

INTRODUCTION AND OBJECTIVE:Inflammation and oxidative stress plays a central role in the etiology and progression of Benign Prostatic Hyperplasia (BPH), a common urological disorder in aged men. Pu...

A Review of Sleep Disturbance and Sexual Function: the Effect of Sleep Apnea on Erectile Function

We sought to produce a review of studies that examine how lack of sleep can modulate male sexual function, with a particular focus on recent findings about sleep apnea and erectile dysfunction (ED) and to examine novel therapeutic approaches proposed in the literature to provide literature on novel therapeutic approaches. Studies have shown that continuous positive airway pressure (CPAP), ??? used as standard therapy for obstructive sleep apnea (OSA) ??? is associated with a clinically significant improvement in the following sexual issues: erectile function, total erectile events, night penis stiffness, overall sexual satisfaction. Recent research has indicated that insufficient sleep, interrupted sleep, and sleep disorders affect sexual function. Sleep is fundamental for quality of life, but with the increasing pressures exerted by modern life there is a tendency for a reduction in sleep time. The resulting sleep debt can have a significant impact on health, including on sexual health. Penile erection is essential for reproductive success and depends on the integration of psychological, vascular, endocrine, neurological, and myogenic mechanisms, triggered by a reflexive response or by psychogenic stimuli of central origin. During sleep, erections can occur through impulses sent through the descending pathway, via spinal medulla that activate the penile system reflex in healthy males from birth until old age, independent of the dream content. OSA is associated with an increased risk of ED and/or other urological disorders. Patients with severe OSA have low testosterone concentrations and a higher prevalence of ED.

Assessment of the quality of the 4th year surgical curriculum at the Pomeranian Medical University in Szczecin for the academic year 2016/2017

Abstract Introduction: The objective of this study was assessment of the course, quality and accomplishment of 4th year surgical curriculum in Pomeranian Medical University in Szczecin (in Poland) for the academic year 2016/2017. Materials and methods: A questionnaire-survey was carried out in a group of 97 Polish students in the 5th year of the Medical Faculty just before the seminar-block of surgery. Main topics of the questionnaire items concerned students’ opinion on the expected usefulness of the acquired surgical knowledge for future medical practice, acquired manual skills, classes conducted in the operative theatre and overall organization of classes. Results: Knowledge from general surgery was scored by students the highest as potentially most useful for future medical practice. Assisting in operations and learning manual skills (mostly inserting stitches on a pig trotter) was considered the most valuable portion of surgical curriculum. These skills were also believed to be the closest to the meaning of the term “skill/competency-oriented teaching” surgery. Theatre classes were considered valuable only for students assisting in operations, but for most of the passive observers it was a waste of time. Less than a half the students took history and examined patients with common urological and surgical disorders. Most (96%) responders considered an inadequate amount of time assigned for manual skills and ward-round teaching the greatest drawback of the 4th year surgical curriculum. Conclusions: Outcomes of this study showed the students’ expectations in surgery lessons in 4th year of university curriculum and what a grade of its performance was. Awareness of this may have an effect on modification of the curriculum and methods of undergraduate teaching surgery.

Association of kidney stone disease with dietary factors: a review

Kidney stone disease is one of the most common urologic disorders worldwide. The incidence of kidney stones disease is increasing all over the world. It is a multifactorial disease accompanied by various factors. The dietary factor is one of the most important risk factors for the formation and recurrence of kidney stone disease. Formation and recurrence of kidney stone disease can be prevented by modifying our day to day dietary habits. Fewer intakes of animal protein, higher intake of fluid, higher intake of fruits, and higher intake of green leafy vegetables, which contain a low amount of oxalate, can prevent the formation of kidney stones and recurrence of kidney stones. From this review, it may be presumed that the higher prevalence rate of kidney stone disease in northeast India may be the dietary factors accompanied by environmental and climatic conditions of the region.

Urinary bladder sigma-1 receptors: A new target for cystitis treatment

No adequate treatment is available for painful urinary bladder disorders such as interstitial cystitis/bladder pain syndrome, and the identification of new urological therapeutic targets is an unmet need. The sigma-1 receptor (σ1-R) modulates somatic pain, but its role in painful urological disorders is unexplored. The urothelium expresses many receptors typical of primary sensory neurons (e.g. TRPV1, TRPA1 and P2X3) and high levels of σ1-R have been found in these neurons; we therefore hypothesized that σ1-R may also be expressed in the urothelium and may have functional relevance in this tissue. With western blotting and immunohistochemical methods, we detected σ1-R in the urinary bladder in wild-type (WT) but not in σ1-R-knockout (σ1-KO) mice. Interestingly, σ1-R was located in the bladder urothelium not only in mouse, but also in human bladder sections. The severity of histopathological (edema, hemorrhage and urothelial desquamation) and biochemical alterations (enhanced myeloperoxidase activity and phosphorylation of extracellular regulated kinases 1/2 [pERK1/2]) that characterize cyclophosphamide-induced cystitis was lower in σ1-KO than in WT mice. Moreover, cyclophosphamide-induced pain behaviors and referred mechanical hyperalgesia were dose-dependently reduced by σ1-R antagonists (BD-1063, NE-100 and S1RA) in WT but not in σ1-KO mice. In contrast, the analgesic effect of morphine was greater in σ1-KO than in WT mice. Together these findings suggest that σ1-R plays a functional role in the mechanisms underlying cyclophosphamide-induced cystitis, and modulates morphine analgesia against urological pain. Therefore, σ1-R may represent a new drug target for urinary bladder disorders.