Urological Examination Research Articles

Осознанный подход к выбору консервативной терапии ДГПЖ

The follow-up results, as well as own case study, are presented to evaluate the efficacy and tolerability of creeping palm fruit extract (Permixon) in combination with an α-blocker in patients with lower urinary tract symptoms (LUTS) of moderate severity associated with benign prostatic hyperplasia (BPH). The follow-up study involved 58 male patients aged 48 to 70 years (mean age 60.1±3.4 years). Group 1 (n=30) was assigned a combined therapy with Tamsulosin (alpha blocker) (0.4 mg once daily) and Permixon (1 capsule, 160 mg, twice daily) for 6 months. Group 2 (n=28) underwent monotherapy with Tamsulosin (0.4 mg once daily) also for 6 months. The observed patients underwent a comprehensive urological examination, which included an assessment of symptoms in points on IPSS (International Prostate Symptom Score); laboratory and instrumental studies. The patients were examined before and 3 and 6 months after therapy initiation. Therapy tolerability was assessed by the frequency and severity of local and/or systemic adverse events. Initially, the maximum urinary flow rate, residual urine volume, IPSS and prostate volume in patients from both groups did not differ statistically significantly. In the intergroup comparison, by 6 months of treatment (versus the treatment initiation), the average urinary flow rates in group 1 increased almost twice, and in group 2 only by 18% (p<0.05). There was a decrease in the residual urine volume in patients of groups 1 and 2, respectively, by 52.6 and 22.6% (p<0.05). The sum of the IPSS decreased by 46.1 and 21.5%, respectively (p<0.05). At the same time, no significant tendency in the volume of the prostate gland in group 2 were revealed in the first 3 months of therapy, However, after 6 months there was an increase in the average prostate volume by 8.8%. In group 1, prostate volume decreased by almost 20% over 6 months of therapy. The tolerability of the studied drug was satisfactory; no adverse events were noted in any patient. Permixone is an effective drug with a high safety profile within the pathogenetic therapy of BPH, affecting a number of factors concerning the development and progression of this disease KEYWORDS: benign prostatic hyperplasia, lower urinary tract symptoms, microcirculation, Serenoa repens, phytotherapy, Laser Doppler flowmetry FOR CITATION: Nashivochnikova N.A. Informed method of choice concerning conservative therapy of BPH. Russian Medical Inquiry. 2022;6(4):187–194 (in Russ.). DOI: 10.32364/2587-6821-2022-6-4-187-194.

Persistent dysuria in women: etiological diagnostics and treatment

INTRODUCTION: Dysuria is a painful urination combined with its frequency and/or difficulty. Dysuria is observed in many urological diseases and is one of the most common reasons for treatment for urological cause.
 AIM: The aim of the study is to identify the etiological factors of dysuria in women and to evaluate a personalized approach to their treatment.
 MATERIALS AND METHODS: We analyzed the data of 368 women with chronical cystitis. The inclusion criteria for the study were the presence of dysuria (painful and frequent urination more than 8 times a day with or without difficulty), the prescription of urination disorders over one year old and age 18 and over. All patients underwent a comprehensive urological examination to identify the causes of urinary disorders.
 RESULTS: The Bacterial cystitis was confirmed only in 78 (21.2%) patients among all 368 women. In the remaining 290 (78.8%) patients, the causes of persistent dysuria were other diseases: bladder leukoplakia in 154 (41.8%), bladder pain syndrome/interstitial cystitis in 38 (10.3%), viral cystitis in 34 (9.3%), paraurethral formations in 29 (7.9%), neurogenic urinary dysfunction bladder in 25 (6.8%), urethral pain syndrome in 5 (1.4%) patients. Dysuria was also caused by postradiation cystitis (2 patients), secondary stones in the urinary bladder (2 patients), and one patient had extragenital endometriosis.
 CONCLUSIONS: The variety of reasons for the development of persistent dysuria in women requires careful examination of patients. Treatment should be carried out only after accurate verification of the diagnosis.

Комплексный подход к лечению стриктур уретры, вызванных склероатрофическим лихеном

Aim to evaluate the correctness of the diagnosis of lichen sclerosus with an evaluation of complications in the form of urethral strictures and to ensure long-term monitoring of patient management in order to avoid recurrence of fibrous complications and ascending infection in case of lower urinary tract obstruction. Material and methods a total of 55 men aged from 17 to 85 years with lichen sclerosus complicated by urethral stricture who were treated from 2005 to 2020 were included in the study. All patients underwent a comprehensive urological examination. From them, 18 (32.7%) patients had previously undergone various types of urethral procedures and were admitted with recurrent urethral stricture for repeated surgery. Results an examination of patients with lichen sclerosus complicated by urethral strictures is presented, including a morphological assessment of the resected tissue and analysis of etiopathogenetic factors. In addition, the results of complex treatment of patients with urethral strictures associated with sclerosus were evaluated. An increase in the maximum urine flow rate and a decrease in post-void residual volume by almost three times was noted 1-3 months after urethroplasty. After 6 months, a recovery of an adequate micturition and complete absence of residual urine were revealed. The morphological picture in patients with urethral strictures associated with lichen sclerosus is characterized by focal atrophy of the epidermis, replacement of the columnar epithelium with a stratified epithelium with signs of hyperkeratosis and acanthosis, histiolymphocytic infiltration, and the formation of microcalcifications under the basement membrane. Conclusion the correctness of the diagnosis verification and the choice of the treatment strategy in patients with urethral strictures caused by lichen sclerosus significantly contributes to the favorable outcomes. Based on comparative analysis, we can conclude than complex approach to the treatment of patients with urethral strictures associated with lichen sclerosus is highly effective.

INFLUENCE OF INGUINAL HERNIA REPAIR ON SPERM AUTOIMMUNITY: THE LARGEST SINGLE CENTER EXPERIENCE

To assess if previous andrological surgery can influence development of antisperm antibodies. This retrospective study includes all infertile male patients (n = 2,415) who underwent MAR (Mixed Autoglobulin Reaction) test and urologic examination visited in a Tertiary Fertility Center, Humanitas Clinical Institute, Rozzano (MI), from 2000 to 2020. Sperm quality (assessed by the number of spermatozoa, their motility, vitality and normal form) was also evaluated. Among these patients, 192 had previously undergone unilateral or bilateral inguinal hernia surgery repair. The aim of the study was to evaluate if there is a higher incidence of positive MAR test among patients undergoing inguinal hernioplasty compared to the unselected infertile population. Antisperm antibody titers were significantly increased in patients who underwent inguinal hernia repair and other andrological surgeries, respectively 3.19 (95%CI 2.02 – 5.04; p <0.001) and 3.71 (95%CI 2.22 – 6.20; p <0.001) higher than the unselected infertile population. Except for autoimmunity, the sperm quality parameters did not change following andrological surgery. MAR test could be useful in patients undergone previous scrotal surgery or hernia correction men, to avoid false unexplained infertility diagnosis and to direct the couple to ART procedures.

X-ray endovascular methods for the treatment of veno-occlusive erectile dysfunction

The results of surgical treatment of 59 patients with veno-occlusive erectile dysfunction and follow-up of 8 years are presented. The age of patients is 18-48 years old (average age is 29.3 ± 7.6). Five of them had hemodynamic and clinical signs of arteriovenous erectile dysfunction in the stage of subcompensation, 16 patients underwent simultaneous treatment in the form of sclerotherapy of testicular veins in connection with the secretory type of male infertility, 5 underwent simultaneous surgical treatment to eliminate veno-occlusive and arterial insufficiency of the cavernous bodies of the penis by stenting of the internal iliac or pudendal arteries, 2 patients underwent delayed stenting of the iliac veins due to May-Turner syndrome, the remaining patients underwent surgical treatment aimed at eliminating venous erectile dysfunction. The diagnosis was established on the basis of a clinical and urological examination, including physical examination and questioning according to the IIEF-5 (International Index of Erectile Function), ultrasound Doppler examination of the cavernous bodies of the penis with intracavernous pharmacotest, dynamic computer pharmacocavernosography with 3D reconstruction, with veno-occlusive arteries with suspected arteries, or computer tomography arterial insufficiency of the cavernous bodies of the penis. All types of endovascular and hybrid operations on the venous collectors of the penis were analyzed. Priority surgical techniques for the treatment of pathological venous drainage have been identified, which are 75 % effective in the long-term postoperative period. Based on the presented experience of the authors and analysis of foreign literature, the expediency of revising the European and Russian recommendations for venous surgery of the penis towards the priority use at the first stage of minimally invasive X-ray surgical treatment in a category of young patients has been proved.

Experience of rehabilitation in children with chronic pyelonephritis living in industrial city

The consistently high frequency of pathology of urinary system in children dictates the need to find new methods for the treatment and prevention of pyelonephritis.Goal. To study clinical and laboratory indicators of health status in children with chronic pyelonephritis living in the industrial city of Tomsk and evaluate the effectiveness of various rehabilitation treatment regimens.Material and Methods. The kidney and urology examinations were performed in 58 children with a diagnosis of chronic pyelonephritis aged 7 to 12 years. Two treatment schemes including administration of mineral water and physiotherapy were used.Results and Discussion. The following symptoms were detected before treatment: oxaluria in 22.41% of children, microhematuria in 17.24% of children, significant increase in serum and morning urine nitrate/nitrite levels, and microalbuminuria suggesting the instability of cell membranes and inflammatory process in renal tissue.Conclusion. The administration of low-mineralized magnesium-sodium chloride-sulfate water in combination with physical therapy, manual massage, sapropel applications, interference therapy, and enteric oxygen therapy lead to normalization of clinical and laboratory health status indicators in the main group of patients.

Current Trends in Percutaneous Nephrolithotomy in China: A Spot Survey.

ObjectiveTo describe trends in the procedure of percutaneous nephrolithotomy (PCNL) in China to identify training needs.MethodsA spot survey with 36 questions, which revealed demographic data, patterns of PCNL practice, and opinions regarding specific clinical cases, was administered to Chinese urologists during the 17th National Urological Urolithiasis Symposium held in Dandong in 2018.ResultsOut of 400 participants, 221 responses to the survey were received. PCNL was performed by 80.5% of the participants, and 70.2% of them were senior clinicians. It was found that 91% used the prone decubitus in training programs and 27.6% the modified supine, and 46.6% were apprenticeship trained for PCNL, while 5.6% trained during their residency. The prone position was the preferred decubitus, even for obese patients. All of the urologists established their own access, 93.7% used ultrasonography guidance alone, 70.7% used ultrasonic and/or pneumatic lithotripters, and 29.2% used laser. When exiting the kidney, 73.8% placed a nephrostomy tube whereas 26.2% used the tubeless technique. For postoperative follow-up, 51.3% used computed tomography (CT) or ultrasonography plus kidney–ureter–bladder (KUB) to monitor the results of procedures, while 45% used KUB alone. Colonic injury was reported by 8.9%. Average hospital stays of >3 days were reported for 81.2% of procedures.ConclusionChinese urologists obtain their own access during PCNL, with ultrasonic guidance in most cases, and almost a half of them are apprenticeship trained. They prefer the prone position, use fascial dilators, and place a nephrostomy tube when exiting the kidney. Most urologists follow the official management guidelines in special cases. Skilled use of urological ultrasound examination, flexible nephroscopy, postoperative CT, tubeless procedures in selected patients, and urology residency training are recommended for PCNL practice.

Диагностика и оперативное лечение гипоспадии у девочек

AIM To suggest new method of surgical correction of hypospadias in girls. MATERIALS AND METHODS For 50 years under our supervision there were 220 girls diagnosed with hypospadias of various forms. In the diagnosis used anamnesis, examination, catheterization and cystoscopy of the bladder, vaginoscopy, ultrasound and X-ray research methods. RESULTS AND DISCUSSION Of 220 girls with a diagnosis of hypospadias, vestibular (partial) hypospadias occurred in 201 girls, vestibulovaginal (subtotal) in 16, and vaginal (total) in 3. Of 201 girls with vestibular hypospadias, 37 suffered from urinary incontinence, 16 had vesicoureteral reflux, 21 had doubling, 5 had renal hypoplasia, and 12 had renal dystopia. The vulvovaginal form was manifested not only by the dystopia of the external opening of the urethra, but also combined with the underdevelopment of the sphincteral apparatus of the bladder. All children had daytime and nighttime urinary incontinence, vulvovaginitis. Cystoscopy revealed hyperemia of the urethra and bladder neck. X-ray urological examination revealed VUR in 6 children, ureterohydronephrosis - in 2. All children suffered from chronic pyelonephritis, 8 - day and night urinary incontinence. There were 3 girls (14-16 years old) with vaginal (total) hypospadias. All suffered from constant urinary incontinence, vulvovaginitis, cystitis, chronic pyelonephritis, all had VUR. The new operation for the vaginal (total) form of hypospadias, proposed by us, restores the closure function of the bladder sphincter by suturing the defect in the posterior wall of the bladder neck. CONCLUSION Hypospadias is rare in girls. There are vestibular, vestibulovaginal and vaginal forms of hypospadias. In most cases, the vestibular form does not require surgical treatment. With the vestibulovaginal and vaginal (total) form of hypospadias, surgical treatment is indicated.

An overview of overactive bladder

Overactive bladder (OAB) is a common multifactorial disease that can cause a burden to the patient. Despite being a symptomatic diagnosis, several urological examinations need to be done to rule out other possible causes. The management of OAB is specific to each individual, from the very first line of behavioral therapy to surgical for an extremely rare case of OAB. This overview will look out for OAB thoroughly from the epidemiological burden, pathophysiology, clinical presentation and diagnosis, and the current treatment of OAB.

Human papilloma virus in the urethra in HIV-infected men in the Рrimorsk region

Objective of the study: identification of HPV and identification of the most common types in urethral swabs taken from HIV-1- infected men, as well as determination of the dependence of the presence of HPV in patients with HIV viral load (VL) and CD4 + T-lymphocyte count.Materials and methods. The study included 34 HIV-1-infected men being monitored at the Center for the Prevention and Control of AIDS and Infectious Diseases (Vladivostok). They were asked to undergo a urological examination, including the collection of urethral swabs, as well as a face-to-face interview to collect socio-demographic, behavioral and clinical-anamnestic data.Results. HIV-1-infected patients (34 people) included in the study were 25–60 (37,8±7,1) years old. HPV was detected in 23 (67,6%) patients aged 25–45 (37,8±5,5) years. The vast majority of patients with multiple HPV infection reported having had sex with three or more sexual partners and did not always use a condom, and 17.4% of the men surveyed said they never used one. In the past, 47.8% of HPV-positive patients used narcotic substances, and 30.4% of the respondents, at the time of the survey, were active users of psychoactive substances. In 23 HIV 1-infected men, 9 genotypes were identified — 6 (HPV-HP), 16, 18, 33, 35, 52, 53, 58, 73 (HPV-VR) — belonging to 5 types of HPV: AlphaPV-6, AlphaPV-7, AlphaPV-9, AlphaPV-10, AlphaPV-11. In 5 patients, coinfection of two genotypes was revealed, in 3 — two types of HPV. The most common genotype was HPV-16 (30,4%) and HPV-18 (26,1%), the least HPV-{6, 58, 73} (1/23≈4,3%). The presented results indicate the need to create diagnostic programs focused on early detection of cancer of the anogenital region in persons of both sexes in patients with immunodeficiency states, primarily in HIV 1-positive patients with HPV-HR.

The relationship between overactive bladder and attachment: A preliminary study.

There are strong relationships between overactive bladder (OAB) and psychological factors. The aim of this study was to examine the relationship between OAB and attachment. Patients who presented with OAB symptoms and were first diagnosed with OAB were included in the study. Patient and control groups were matched in terms of age and gender. A urological and psychiatric examination was performed on each participant. The severity of patients' OAB symptoms was assessed using the Overactive Bladder-V8 Questionnaire (OAB-v8). The characteristics of attachment patterns were evaluated using The Close Relationships Scale Revised. The OAB and control groups included 41 and 43 participants, respectively. No significant difference was found between the two groups with regard to alcohol abuse, daily cigarette consumption, marital status, and gender. The prevalence of anxious attachment was significantly higher in the OAB group than in the control group (p < 0.001), whereas no significant difference was found with regard to avoidant attachment (p = 0.18). A significant relationship was found between the OAB-v8 score and anxious attachment in OAB patients (r = 0.50; p < 0.001). Our findings suggest that insecure attachment, especially anxious attachment is associated with OAB and the severity of OAB symptoms. More extensive and longitudinal studies can better show the relationship between attachment and OAB. Future research may focus on the possibility of causality between attachment and OAB.

Urology at your fingertips: the development of a urology m-learning app for medical students.

BackgroundSurgical education has embraced advancing technology with an emphasis on e-learning in recent years. Smartphones are a useful tool for medical teaching and learning with increasing use by medical students to access e-books, medical calculators, podcasts, and medical applications (apps). Our aim was to develop a dedicated urology app for medical students as an adjunct to traditional teaching.MethodsWe published an e-book: Urology Handbook for Medical Students in 2017 based on the core urology curriculum for medical students. Subsequently, we developed a concise, simple and user-friendly smartphone app for medical students called “Urology Med”, available for download on App Store and Google Play.ResultsThis app is an introduction to urology for medical students but may also be useful for interns and surgical trainees. The app encompasses core urology topics subdivided into common urological presentations, urological examination, urological diseases, and urological devices. To make the app interactive, it includes 5 clinical cases that complement the reading material and six quizzes for self-assessment. A comprehensive checklist of 31 “must see” and “good to see” urology experiences is included. Within one month of launch, the app was downloaded 435 times in five countries across three continents. It has a 5-star rating on the Apple store.ConclusionsHigh educational standards with relevant content make e-learning a valuable learning tool for surgical education. The Urology Med app facilitates easy access to urology and is ideal for quick reading while working or revising.

Self- and proxy-reported outcomes after surgery in people with disorders/differences of sex development (DSD) in Europe (dsd-LIFE)

Surgery is performed in many individuals with disorders/differences of sex development (DSD). Irreversibility of some surgical procedures, lack of information about the procedures, and lack of follow-up care for physical and psychological outcomes, lead to wish for more knowledge from both surgeons and patients. After the consensus conference in 2006, multidisciplinary care is provided to a higher degree with psychological support and more restricted surgical procedures. Outcome studies after genital surgery often lack of patient's perspective. To describe surgical procedures in relation to diagnosis, to evaluate the outcomes of surgery through genital examination, and through patient's and observer's satisfaction with the anatomical and functional result after genital surgery. In a cross-sectional clinical study performed in six European countries in 2014/15, we have included 500 participants where surgery was performed, from a total of 1040 adolescents (≥16years) and adults with a DSD. Diagnoses included Turner syndrome (n=301), mixed gonadal dysgenesis (45,XO/46,XY; n=45), Klinefelter syndrome (n=218), XYY (n=1), 46, XY DSD (n=222) and 46, XX DSD (n=253). Study protocol included clinical report files, an optional gynecological or urological examination, patient reported outcomes including received surgical interventions, satisfaction with appearance and function after surgery, and impact of the surgical procedure on life. Five hundred participants had received genital or breast surgery, with the highest rate in 46, XY DSD and the lowest in Turner syndrome. Altogether; 240 participants had feminizing surgery, 112 had masculinizing surgery, and 217 underwent gonadectomy. Physicians evaluated anatomical appearance at genital examination as poor in less than 10%. Dissatisfaction with anatomical appearance was reported by 22% of the participants, dissatisfaction with function by 20%. Being (very) dissatisfied with anatomical appearance and function was reported by 13% of the study participants. Most participants reported no impact, or positive impact, of the surgical procedures on their lives, but 29% experienced a negative effect of gonadectomy on their life. There might be a selection bias and/or a recall bias for participating in our studies. Due to poor data quality about surgical procedures performed in the past, we also relied on participants memory about surgical procedures in their past. Ideally, patient reported outcomes should be evaluated both before and after surgical procedures. A vast majority are satisfied with appearance and function, but still genital or breast surgery have a long-lasting effect on patient's life. Self-reported satisfaction is usually lower than the observer's evaluation regarding both appearance and function.

A complex case of neuro-muscular rehabilitation with favorable evolution, in a patient with incomplete tetraplegia post cervical and thoracic spinal cord injury - surgically treated, in a politraumatic context, by car accident

Introduction: Spinal cord injuries (SCI) are major conditions that usually determine severe and permanent dysfunctions, or even important loss of basic functions, generating severe or rather permanent sequels. They can have important chronic consequences such as: tetraplegia or paraplegia.(1). Materials and Methods: This paper presents the case of a young 19-year-old patient who suffered in March 2019, a car accident (passenger) with spinal cord injury (SCI) at cervical and thoracic level in a politraumatic context, hospitalized at the Neurosurgery Clinic (NS) II of TEHBA in a severe condition, for complete AIS/Frankel A tetraplegia, with a C7 fracture, T3, T4, T5 cominutive fractures with fragments in the medullary channel, minor traumatic brain injury, multiple costal fractures, abdominal trauma and respiratory failure. When the patient became hemodynamic and respiratory stable it was decided a neuro-surgical intervention, initially at cervical level through an anterior approach, with mixed osteo-sinthesis and C7 discectomy. Because of the spine instability, thoracic surgical treatment was delayed with 11 days, when he suffers a neurosurgery for medullary decompression, drainage and stabilization of the spine. In our clinical division, the patient was admitted with an incomplete AIS/Frankel B tetraplegia and initially followed a rehabilitation nursing program and subsequently continued with a recovery therapy according to clinical stages. The patient was assessed functionally using the following scales: AIS/Frankel, modified Ashworth, Functional Independence Measure (FIM), Life Quality Assessment (QOL), FAC International Scale, Independence Assessment Scale in Daily Activities (ADL / IADL), Walking Scale for Spinal Cord Injury (WISCI). Results: The patient benefited from a complex neuro-muscular rehabilitation program, having a favorable evolution, with an increase in the evaluated scales scores – passing from AIS/Frankel B classification to a severe AIS/Frankel C stage, and thus, at the moment he is performing walking on short distances, through parallel bars, with long left leg orthosis and support from another person. It was tried a sphincter re-education, but, after urologic examination, because of the important spasticity in the lower limbs and of the urinary catheterization discomfort, it was decided that for a while the patient to remain with fixed urinary catheterization. Conclusions: Even if there is still no cure for SCI sequels, the accurate clinical-functional evaluation, the neurosurgical prompt therapeutic approach, adding complex nursing measures, personalized rehabilitative and kinetotherapy programs, in a young patient with SCI by car accident, determined neuro-locomotor improvements with an increase in patient’s quality of life.(1),(2). Keywords: spinal cord injuries, tetraplegia, traumatism, rehabilitation,

Identification and Analysis of a Novel NR0B1 Mutation in Late-Onset Adrenal Hypoplasia Congenita and Hypogonadism

ObjectiveX-linked adrenal hypoplasia congenita (AHC) is a rare disorder characterized by primary adrenal insufficiency and hypogonadotropic hypogonadism (HHG) caused by mutations of the NR0B1/DAX1 gene. We aimed to search for the presence of any NR0B1/DAX1 gene mutations in a referred patient and to further characterize the phenotypes of the identified mutation.Case PresentationHerein, we report a Japanese patient with a novel missense mutation of the NR0B1/DAX1 gene resulting in adult-onset AHC and HHG. The patient was referred with diffuse skin pigmentation at 28 years of age, presented partial adrenal insufficiency and had undiagnosed incomplete HHG. Urological examination revealed severe oligospermia and testicular microlithiasis.ResultsThe NR0B1/DAX1 gene mutation was identified by exome sequencing as a novel missense mutation (c.884A>T, p.Leu295His). We conducted in silico modeling of this mutant NR0B1/DAX1 protein (p.Leu295His) which affected the conserved hydrophobic core of the putative ligand-binding domain (LBD). In addition, functional analysis revealed that this mutant showed a decreased ability as a transcriptional repressor to suppress target genes, such as STAR and LHB. Furthermore, this mutant showed functionally impaired repression of steroidogenesis in human adrenocortical H295R cells.ConclusionsWe identified a novel missense mutation of the NR0B1/DAX1 gene in a patient suffering from late-onset AHC and HHG, who presented with oligospermia and testicular microlithiasis. This mutant NR0B1/DAX1 protein was found to have reduced repressor activity, according to in vitro studies, clinically consistent with the patient’s phenotypic features.

What has changed during the state of emergency due to COVID-19 on an Academic Urology Department of a Tertiary Hospital in Portugal

ObjectiveTo compare the activity the Urology Department of a Portuguese Academic Hospital during the state of emergency and the equivalent period at the previous year. We compared the number of elective consultations and diagnostic urologic examinations, number and type of elective surgeries, as well as patients’ demographic characteristics and main causes of presentation to Urology Emergency Department (ED) during the two mentioned periods. Materials and methodsData from 691 patients coming to emergency department were collected from institutional clinical software from March 18th 2020 to May 2nd 2020—and from the same period the previous year. Data collected were age, sex, day of the presentation to Emergency Department, referral from other hospitals, triage color, reason of admission, diagnosis of discharge, and the need for emergency surgery or hospitalization. In order to identify associations between demographic and clinical variables with having been submitted to an emergency surgery (outcome), logistic regression models were applied. ResultsMultivariable analysis showed an association of sex with being submitted to surgery, 65.6% decrease in the odds for the male gender. The period (COVID versus non-COVID) did not show a significant association with surgery. ConclusionOur department experienced an noticeable activity reduction. We also observe a reduction in urgent causes to attend the ED considered less serious. The percentage of cases requiring emergency surgery and hospitalization was higher during COVID-period.

Transurethral Resection of Bladder Neck in the Management of Primary Bladder Neck Obstruction in Female: Our Preliminary Experience in Bangladesh

Objectives: To determine the effectiveness of transurethral resection of bladder neck in the management of primary bladder neck obstruction (PBNO) in female Patients and Methods: This prospective study has been done with thirty female patients aged from 27 to 48 years who were presented with difficult micturition or urinary retention. These patients had unremarkable physical findings with normal perianal sensation, anal sphincter tone and lower extremity reflexes. Patients associated with cystocele, meatal stenosis, stricture urethra, urethral caruncle and urethral diverticula that may lead to mechanical bladder outflow obstruction were excluded from the study. Preoperative investigations include uroflowmetry, ultrasonography, serum creatinine, urethrocystoscopy with simultaneous “water flow test” was done. Seven patients presented with obstructed voiding symptom without renal impairment (serum creatinine, mean±SEM 1.24±0.04) and were initially treated with á-blocker (category A). Among the other 23 patients those had renal impairment 18 presented with near retention and these patients were on indwelling catheterization before operation (category B, serum creatinine, mean±SEM 2.72±0.13).Rest of the 5 patients presented with nausea, vomiting, and disorientation in addition to near retention and were put on haemodialysis along with indwelling catheterization to reach near normal creatinine level before operation(category C, serum creatinine, mean±SEM,9.34±0.96 ). PBNO causing voiding difficulty were diagnosed in all the cases and were undergone transurethral bladder neck resection (BNR). Three months after operations, their pre- and post-operative symptoms were analyzed, and serum creatinine levels, ultrasonographic findings (MCC, PVR), uroflowmetric study were compared. Results: Twenty-nine (96.33%) Patients become symptom free. Their average pre- and post-operative values of MCC (Maximum Cystometric Capacity), PVR (Post Voidal Residual urine), Qmax (Peak urinary flow during uroflowmetric study, Serum creatinine level were changed from 679.50 to 482.17ml, from 574.50 to 29.37ml, from 8.43 to 29.37ml/sec, from 3.48 to 1.13 mg/dl respectively. One patient (3.33%) did not continent ever postoperatively. One patient had become dry after using pad for stress incontinent for one month only. Serum creatinine level of category C patient did not reach to the normal level (post operative creatinine level Mean±SEM,2.8±0.15)within this three moths follow up period. Conclusions: Our short term follow-up suggests that judicious Transurethral BNR is effective in relieving voiding difficulty due to primary bladder neck obstruction in female. A thorough gynaecological, neurological and urological examination is essential along with uroflowmetric, ultrasonographic and cystoscopic study to reach a correct diagnosis and making a treatment plan. Bangladesh Journal of Urology, Vol. 17, No. 1, Jan 2014 p.23-28

The association between burning mouth syndrome and urologic chronic pelvic pain syndrome: A case‐control study

The overlap between some painful conditions is widespread. The aim of this study was to evaluate the overlap between burning mouth syndrome (BMS) and urological chronic pelvic pain syndrome (UCPPS) in an outpatient clinic of a university hospital. A controlled clinical study was performed. BMS patients and healthy controls were enrolled in the study. Patients were screened through laboratory test and a complete urological examination. Two validated questionnaires were submitted to all the patients: National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostatic Symptom Score (IPSS). A total of 50 BMS patients and 50 healthy controls were enrolled in the study. Statistically significant differences between the two groups regarding the items of the IPSS questionnaire of Incomplete Emptying (U=750, P<.001), Intermittency (U=768.5, P<.001), QoL (U=848, P<.002), and Total Symptom score (U=1040, P=.05) were found. Moreover, the responses of NIH-CPSI showed statistically significant differences regarding Pain subscale (U=714, P<.001), QoL Impact subscale (U=1016.500, P=.05), and NIH-CPSI total score (U=953.500, P=.002). To the best our knowledge, the reported data demonstrate for the first time an association between BMS and UCPPS. Further studies with a larger sample are needed to confirm the co-occurrence of urological symptoms in patients with burning mouth syndrome.

Relationships among cigarette smoking, urinary biomarkers, and urothelial carcinoma risk: a case-control study.

Cigarette smoke is a known risk factor for urothelial carcinoma (UC). However, there is limited information about the distributions and effects of volatile organic compounds (VOCs) on smoking-related UC risk. With this hospital-based case-control study, we explored the associations between urinary levels of cotinine and VOC metabolites (acrylamide, 1,3-butadiene, and benzene) and the risk of UC. Urological examinations and pathological verifications were used to confirm the diagnoses of UC. All study participants provided smoking-related information via questionnaires and face-to-face interviews; they also provided urine samples for the measurement of VOC metabolites, cotinine, and 8-hydroxydeoxyguanosine (8-OHdG), which was used as an indicator of oxidative stress. We applied multiple logistic regression analysis to estimate the risk of UC, and we found that levels of urinary cotinine and 8-OHdG were higher in the UC group than in the control group. Furthermore, urinary levels of VOC metabolites, including N-acetyl-S-(2-carbamoylethyl)-L-cysteine (AAMA), N-acetyl-S-(2-carbamoyl-2-hydroxyethyl)-L-cysteine, N-acetyl-S-(4-hydroxy-2-buten-1-yl)-L-cysteine-3, trans,trans-muconic acid (t,t-MA), and S-phenylmercapturic acid (SPMA), increased with increasing levels of urinary cotinine. After adjusting for potential risk factors, dose-response relationships were observed between UC risk and urinary levels of AAMA, t,t-MA, SPMA, and 8-OHdG. Participants with high urinary levels of cotinine, AAMA, t,t-MA, SPMA, and 8-OHdG had risks of UC that were 3.5- to 6-fold higher than those of participants with lower levels. Future, large-scale investigations of the risks of UC should be explored, and repeated measurement of VOC metabolites should be assessed.

Los cambios producidos durante el estado de alarma debido a la COVID-19 en un Servicio de Urología de un Hospital Universitario Terciario en Portugal

ObjectiveTo compare the activity the Urology Department of a Portuguese Academic Hospital during the state of emergency and the equivalent period at the previous year. We compared the number of elective consultations and diagnostic urologic examinations, number and type of elective surgeries, as well as patients’ demographic characteristics and main causes of presentation to Urology Emergency Department (ED) during the two mentioned periods Materials and methodsData from 691 patients coming to emergency department were collected from institutional clinical software from March 18 th 2020 to May 2 nd 2020 - and from the same period the previous year. Data collected were age, sex, day of the presentation to Emergency Department, referral from other hospitals, triage color, reason of admission, diagnosis of discharge, and the need for emergency surgery or hospitalization. In order to identify associations between demographic and clinical variables with having been submitted to an emergency surgery (outcome), logistic regression models were applied. ResultsMultivariable analysis showed an association of sex with being submitted to surgery, 65.6% decrease in the odds for the male gender. The period (COVID versus non-COVID) did not show a significant association with surgery. ConclusionOur department experienced a noticeable activity reduction. We also observe a reduction in urgent causes to attend the ED considered less serious. The percentage of cases requiring emergency surgery and hospitalization was higher during COVID-period.