Urological Examination Research Articles

Impact of untreated positive urine culture on urinary tract infections after cystoscopy

Cystoscopy is the most commonly performed urological examination during consultation. Various guidelines outline the benefits of performing urine culture before cystoscopy. The main objective of this study was to evaluate the impact of untreated positive urine cultures before cystoscopy on postinterventional urinary tract infection (UTI) rate. The secondary objectives were to identify factors favoring UTI and analyze the correlation between bacteria found before and after cystoscopy. All patients who underwent cystoscopy in our hospital from November 2020 to March 2022 were included. Pregnant women and patients under antibiotic therapy were excluded. A urine culture was collected on the examination day, and the patients filled out a questionnaire one month later, indicating symptom occurrence. The primary outcome was UTI in the month following cystoscopy, defined according French Society for Infectious Diseases (SPILF) criteria by the presence of fever or at least one lower urinary tract symptom (pollakiuria, burning sensation during urination, urgent urination) and a positive uroculture (defined by SPILF criteria). The study included 410 patients. A positive precystoscopy uroculture was noted in 80 (19.5%) patients. Factors significantly associated with UTI were a positive precystoscopy urine culture (11% vs. 1.5%, OR = 7.64 [2.44-23.9]) and the presence of voiding LUTS (8.5% vs. 1.9%, OR = 4.42 [1.39-13.05]). Age, sex, the presence of a urethral catheter, and cystoscopy indication were not significantly associated with UTI. Only one patient, in the positive uroculture group, was hospitalized. For five patients, the microorganism found in the postcystoscopy urine culture was the same as that identified in the precystoscopy urine culture, with the same resistance profile on the antibiograms. The number needed to treat to prevent one UTI is 16. Bacteriuria is associated with a higher UTI rate after cystoscopy. Nevertheless, the benefit of treating a positive uroculture before cystoscopy remains unclear.

Urological Examination Compared to Ultrasonography in Testicular Lump Assessment: A Retrospective Cohort Study.

Background General practitioners (GPs) often expedite indeterminate scrotal lumpsfor urological evaluation. While a scrotal examination by a urologist is crucial, ultrasound (US) has become a routine component of clinical assessment regardless of the clinical examination findingsand the nature of the symptoms. This study aimed to evaluate the efficacy of clinical examination compared to scrotal ultrasound, even when the suspicion of cancer was low. Methodology A retrospective review of all fast-track testicular referrals seen in the clinic between January 2018 and January 2021 was conducted. Data on clinical examination findings, ultrasound results, and final diagnoses were analyzed. Patients for whom ultrasound scans were available before clinical examination were excluded from the study to avoid confounding the results. Results A total of 398 male subjects were referred for urological assessment, and 123 cases were excluded based on specified exclusion criteria. Two hundred seventy-five patients were identified who underwent clinical examination by urologists and subsequent ultrasound scans. Among 30 (11%) potentially malignant cases, 18 (60%) were confirmed malignancies. Sixty-eight (24.7%) cases were deemed unlikely to be malignant, and an ultrasound scan confirmed 40 (58.8%) cases as normal and four (5.9%) cases of unexpected malignancy. Ultrasonography confirmed 19 of 27 hydroceles (70.4%), 64 of 89 epididymal cysts (71.9%), and 5 of 9 varicoceles (55.6%). Of 51 epididymo-orchitis cases, 14 (27.5%) were confirmed. Conclusions Urological examinations demonstrated high reliability in most cases, with clinical diagnoses frequently corroborated by ultrasonographic findings. The results indicate that when there is no clinical indication for an ultrasound scan, it is more efficient to avoid unnecessary ultrasonography, as it can be time-consuming without providing additional diagnostic benefits. This underscores the value of thorough clinical assessment in guiding the need for further imaging.

The Relationship Between Emotional Disorders and the Duration of Remission in Chronic Prostatitis/Chronic Pelvic Pain Syndrome

The cause of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is often multifactorial and not fully known. Despite limitations and variations in sample size, study design, and diagnostic procedures, there are many studies that show an association between CP/CPPS and psychological problems. The existing evidence does not permit to conclude whether emotional problems are risk factor for CP/CPPS or whether they represent an array of symptoms that are associated with the exacerbation of this disease. The objective: to examine the association of subclinical anxiety, depression, and stress with exacerbation of urological symptoms in patients with CP/CPPS. Materials and methods. The study included 78 patients with established CP/CPPS. Mean age of patients was 46.9±9.3 years. All patients were referred from various urological clinics and underwent a thorough urological examination. All of them signed informed consent to participate in the study. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was used to comprehensively assess symptoms of CP/CPPS and evaluate the dynamics of prostatitis symptoms. The patients emotional state and its relationship to stress was assessed using the “Depression, Anxiety and Stress Scale-21” questionnaire (DASS-21). The patients were observed for one year period and over. The exacerbation of urological symptoms was studied as endpoint of evaluation. The design of the study was planned as a “case-control” study. The “case” (Group 1 – 28 patients) were patients with depression, anxiety and stress observed simultaneously according to the DASS-21 questionnaire. The “control” (Group 2 – 26 patients) included patients without depression, anxiety, and stress, matched for age and other factors to Group 1. Results. The Quality of Life (QoL) Score NIH-CPSI in Group 1 is significantly higher than in Group 2 – (8.13±1.4) points in Group 1 and (5.42±1.4) points in Group 2. The Pain and Dysuria Score did not differ significantly in both groups. All DASS-21 indicators in Group 1 were significantly higher. However, this was determined by the study conditions. Group 1 recruited patients whose Depression score, Anxiety score, and Stress score corresponded to moderate symptoms, while Group 2 included patients whose levels of these indicators were below moderate. In addition, the duration of remission in Group 1 was significantly shorter than in Group 2. The correlation coefficients between the scale scores and the duration of remission were also studied. The duration of CP/CPPS remission was associated with strong negative relationships with NIH-CPSI Quality of Life score (rs=–0.666), DASS-21 Depression score (rs=–0.779), DASS-21 total score (rs=–0.603) and had a moderate correlation with DASS-21 Stress score (rs=–0.364). The mutual influence of the indicators of the two scales on each other was also revealed. Thus, the QoL score NIH-CPSI had a significant positive correlation with the Depression score DASS-21 (rs= 0.714) and a moderate positive correlation with the Stress score DASS-21 (rs= 0.305). Conclusions. It was shown that depression signs form an affective style of response to stress and closely relate with remission duration. The DASS-21 questionnaire can be an available tool for diagnosing disorders of the emotional state and possible prediction of subsequent exacerbations of CP/CPPS.

Urinary disorders in patients diagnosed with organic brain pathology

Introduction. This study is relevant due to the high prevalence of organic brain pathology and the negative influence of urination disorders on the quality of life.Objective. To analyse the impaired function of lower urinary tracts in patients with organic brain pathology.Materials & methods. We analysed 607 patients with severe organic brain pathology (105 had traumatic spinal cord injury (TSCI) and 457 had consequences of acute stroke (AS)). We performed clinical urological examinations. During the survey, attention was paid to the presence of urinary tract pathology at the examining time and anamnesis. Structural changes in the urinary tract were objectively assessed. We objectively assessed structural changes in urinary tracts including prostate adenoma in men, insufficiency of pelvic floor muscles in women and strictures of the urethra or ureters. The degree of the spastic syndrome was assessed with the Ashworth Scale. The neurourological examination included cystometry with the measurement of bladder volume and post-void residual urine. The cognitive status of the patients was assessed with the MMSE (Mini-Mental State Examination) questionnaire. The correlation analysis between the degree of spastic syndrome measured with the Ashworth Scale and urination disorders was performed with Spearman rank correlation.Results. All patients had neurogenic dysfunction of the lower urinary tract. A combination of bladder retention and emptying disorders was found in 62 men older than 45yo with benign prostate hyperplasia (10,2% of all cases). An impaired accumulation function in history was found in 45 women older than 45yo (7,4% of all observations). The level of spasticity was 3 or 4 points on the Ashworth Scale in patients with TSCI and 2 to 4 points in those with AS. The analysis of correlations between the degree of spasticity and urination disorders showed a moderate relationship (r = 0,4) in patients with TSCI and a medium relationship (r = 0.65) in patients with AS.Conclusion. Neurogenic dysfunction of the lower urinary tract accompanies patients with severe organic brain pathology throughout their life and requires adequate correction.

ChatGPT sitting for FRCS Urology examination: Will artificial intelligence get certified?

Introduction: The use of artificial intelligence (AI), including neural networks and deep learning, has rapidly changed many industries. One recent application of AI that has gained the attention of physicians and the general public alike is ChatGPT, a chatbot developed and released by OpenAI Inc. in November2022. We challenged ChatGPT to sit the Fellowship of the Royal College of Surgeons (FRCS) Urology examination, both parts, to assess its performance and determine its eligibility for the title. Methods: We prepared a set of 100 Multiple-Choice Questions (MCQs) for Part 1 and 8 viva scenarios for Part 2. We choose to use ChatGPT 3.5 that is the free version available online, and responses were documented during the simulation. Results: In Part 1 MCQs, Chat Generative Pre-trained Transformer (ChatGPT) managed to answer some questions correctly with an overall score of 35%. However, in Part 2 Viva, its performance improved to an extent, demonstrating proficiency by offering detailed explanations and reasoning, achieving average score in some stations. ChatGPT’s performance raised some concerns on answering questions. Conclusion: AI is definitely an asset that can be used in our daily practice, yet it is crucial to take into consideration the concerns about the accuracy of data provided, including AI hallucination. ChatGPT failed to get the FRCS Urology title this time. Still in the early stages of development, further research is necessary to comprehensively understand their limitations and capabilities. Level of evidence: Not applicable

Evaluation of Ectopic Kidney Located at the Deep Subcutaneous Region of the Abdominal Wall: Role of Diuretic Renography with 99mTc-DTPA.

An ectopic kidney is often found inadvertently during CT, ultrasonography, MRI, or urologic physical examination. Ectopic kidneys usually occur in the pelvis. A pelvic ectopic kidney may be misinterpreted for a pelvic tumor by less experienced physicians and surgeons. We present an extremely rare case of ectopic kidney in the deep subcutaneous region of the abdominal wall and associated with the additional abnormality of spina bifida. MRI found an ectopic kidney but failed to identify ureteropelvic drainage. Diuretic renography with 99mTc-diethylenetriaminepentaacetic acid showed normal functioning and identified nonobstructive ureteropelvic drainage of the ectopic subcutaneous kidney.

Normalization of urination parameters in a boy with cerebral palsy after rehabilitation using an “ExoAtlet” exoskeleton

Lower urinary tract dysfunction occurs in 30%–55.5% of patients with cerebral palsy. The article presents a clinical example of medical rehabilitation of a child with cerebral palsy and dysfunctional urination using the verticalization method and ExoAtlet exoskeleton. Description of observation. A 15-year-old boy had urinary disorders in the form of urine leakage after urination, incomplete emptying of the bladder, episodes of enuresis, and frequent urination while sitting. The gait was unsteady and aided with crutches supported by the elbow. Examinations included uroflowmetry and electromyography. The results indicated a decrease in contractility and impaired evacuation function of the detrusor. In total, 15 rehabilitation sessions were performed using the ExoAtlet exoskeleton, after which the patient gained an independent gait supported by a cane, and the child was taught to urinate in a standing position. A repeat urological examination revealed a positive change in urination parameters with partial relief of pollakiuria and complete relief of the residual bladder volume. Verticalization and activation of striated muscles, obtained following the use of an exoskeleton in a child with cerebral palsy and dysfunctional urination, in combination with restored posture, helped normalize lower urinary tract function.

Features of detrusor function disorders in patients with dysuria in the long period after transurethral resection of the prostate

BACKGROUND: Transurethral resection of the prostate (TURP) remains the “gold standard” for surgical treatment of patients with benign prostatic hyperplasia. At the same time, a significant number of patients continue to have urinary disorders after surgery. Dysuric disorders may be caused by detrusor dysfunction. AIM: The aim of the study was to determine the frequency, nature and clinical manifestations of detrusor dysfunction in patients with benign prostatic hyperplasia after TURP in the long-term postoperative period. MATERIALS AND METHODS: We examined 128 patients with benign prostatic hyperplasia aged from 56 to 87 years (mean 68.5 ± 7.1 years), who underwent TURP 12–36 months before inclusion in the study. All patients had urinary problems at the time of examination. All patients underwent a urological examination, which included a complex urodynamic study. The control group consisted of 48 patients with benign prostatic hyperplasia of comparable age, who did not have urinary disorders after TURP. RESULTS: Urodynamic signs of detrusor dysfunction were identified in 97 (75.8%) of 128 patients examined. Most often, isolated detrusor overactivity was detected (52.6%), less often a combination of detrusor over- and hypoactivity (25.8%) and isolated detrusor hypoactivity (21.7%). In patients with identified detrusor dysfunction, even before TURP, more pronounced urinary disorders were noted, which were characteristic of a certain type of detrusor dysfunction and persisted after surgical treatment. In patients with detrusor dysfunction, compared with patients from the control group, at the preoperative stage, urgency urinary incontinence, frequent urgency to urinate, diabetes mellitus, and a small volume of the prostate gland with the absence of intravesical protrusion were significantly more often detected. CONCLUSIONS: Detrusor dysfunction is an important cause of dysuria in patients with benign prostatic hyperplasia in the long-term period after TURP. It seems appropriate to conduct further research to clarify the indications for performing preoperative complex urodynamic study in patients with benign prostatic hyperplasia and lower urinary tract symptoms.

The effect of overweight and obesity on the severity of manifestations of chronic nonbacterial prostatitis with an inflammatory component

BACKGROUND: Chronic prostatitis is one of the most common urological diseases of young and middle-aged men. The variety of pathogenetic mechanisms and clinical manifestations, the tendency to recurrence necessitates the search for new methods of examination and monitoring of this disease. AIM: To identify the characteristics of the clinical manifestations of chronic non-bacterial prostatitis with an inflammatory component in men of the first period of adulthood, depending on the body mass index. MATERIALS AND METHODS: A comprehensive urological examination was carried out on 150 men with CNVC in the first period of adulthood, aged 22 to 35 years. All patients were assessed for hormonal status, as well as anthropometric parameters. RESULTS: Men with normal body mass index had milder clinical symptoms of prostatitis compared with overweight and obese patients. The results of laboratory studies demonstrated a more pronounced inflammatory process and dysfunction of the prostate in patients with a higher body mass index. Analysis of hormonal status revealed high levels of total and free testosterone and low levels of estradiol in men with normal body mass index. The content of sex hormone-binding globulin was significantly lower in obese patients. Overweight and obese men also had larger prostate volume according to TRUS. CONCLUSIONS: More severe manifestations of prostatitis are associated with an increase in body mass index.

Correlates of sexual and reproductive health service utilization among older adults in China: Findings from the sexual well-being (SWELL) study

BackgroundSexual and reproductive health (SRH) is critical to the overall health of older adults. We assessed the utilization of SRH services and its correlates among older adults in China. MethodsWe recruited community-dwelling adults aged 50 and above in five Chinese cities between June 2020 and December 2022. In this study SRH services included reproductive health examination, cervical cancer screening, and sexual life counselling. Logistic regression was used to assess correlates of SRH services utilization. ResultsA total of 3001 older adults (1819 men and 1182 women) were enrolled. Among them, 11.4 % (343/3001) of participants received a reproductive health examination, 35.4 % (418/1182) of female participants received cervical cancer screening, and 30.1 % (401/1332) of sexually active participants sought help for their sexual lives. Older men with an annual income of USD 7500 or more (aOR = 3.21, 95%CI: 1.39–7.44), two or more chronic conditions (2.38, 1.39–4.08), and reproductive health problems (2.01, 1.18–3.43) were more likely to receive a urological examination. For older women, individuals who were younger (aged 50–59 years: 5.18, 2.84–9.43; aged 60–69 years: 2.67, 1.49–4.79), lived in an urban area (1.88, 1.31–2.71), were employed (1.73, 1.21–2.47), had two or more chronic conditions (2.04, 1.37–3.05), were sexually active (1.72, 1.15–2.58) and talked about sex (1.69, 1.21–2.36) were more likely to receive a gynecological examination. ConclusionSRH services utilization among older adults was low, with urological examination among older men particularly low. SRH messages and services tailored for older adults are needed to enhance their utilization of SRH services.

The relationship between depression, anxiety and lower urinary tract symptoms in men

PurposePatients with lower urinary tract symptoms (LUTS) often experience comorbid depression and anxiety, yet the mechanisms underlying this association remain incompletely understood. This prospective study aimed to investigate the relationship between depression, anxiety, and LUTS in men. Materials and methodsA prospective study was conducted with 350 male patients who underwent urologic examinations at our institution from January 2021 to December 2021. Of these, 131 patients meeting the inclusion criteria were included. Various questionnaires, including the International Prostate Symptom Score (IPSS) and the Hospital Anxiety and Depression Scale (HADS), as well as LUTS examinations (prostate-specific antigen test, transrectal ultrasonography, and urine flowmetry), were administered. ResultsAmong the 350 patients, 131 were included in the analysis, with an average age of 58.0 ± 13.69 years. The total IPSS was 18.0 ± 8.69, with the average voiding symptom score at 8.7 ± 5.19 and the average storage symptom score at 6.0 ± 3.27. Both anxiety and depression were found to be correlated with LUTS (P < 0.05). After adjusting for age, hypertension, and diabetes, anxiety (but not depression) was significantly associated with LUTS based on regression analysis. ConclusionMen with LUTS are more likely to experience anxiety. Therefore, it is essential to assess and address anxiety when managing men with LUTS.

(025) Compliance with GMC Guidelines for the Use of a Chaperone in Urology Outpatient Clinic

Abstract Introduction Intimate physical examination is an integral part of our urological practice. There is a paucity of literature regarding the use of chaperones among urologists. As per GMC guidelines: The offer, and use, of a chaperone, including their full name and designation, should be clearly documented in patients’ notes. Objective Given the importance of this ethical topic for both patient safety as well as in providing support for the urologist, we decided to assess our performance as per the GMC guidelines for good medical practice. Methods We completed an audit loop to evaluate the performance of 12 members in our urology team as regards compliance with GMC guidance for the documentation of chaperone use in urology clinic. Based on our scoring system, we objectively assessed both overall team performance as well as individual scores for documenting chaperone use. • For each urologist, We checked records for 10 patients who attended urology clinic AND had a physical examination as evidenced in the notes and/or clinic letter •N= 120 patient records checked • Each urologist was given a score; NO mention of a chaperone= 0 point A chaperone JUST mentioned= 1 point The chaperone specified (name/signature)= 2 points Results Initial audit revealed overall chaperone documentation in clinical notes was 75.25% which may be acceptable while in the clinic letters, it was only 14.6%. At individual level, results were quiet variable reflecting the actual difference in practice between individuals in real life. Following the discussion of the 1st audit results in the urology clinical governance meeting, posters were made to raise awareness of the audit outcome as well as direct discussions with the urology team members to encourage them to improve their score. Six months later, re-audit showed significant improvement was achieved for individual as well as overall documentation to 85% of clinical notes and more than 50% of clinic letters. Conclusions Documenting chaperone presence during patient examination in urology clinics, is mandatory given the intimate nature of urological examination. We present the first report using a scoring system for objective assessment of a pertinent topic such as the use of chaperone and its documentation. This managed to achieve a significant improvement in our practice in accordance with GMC guidance for Good Medical Practice. Disclosure No.

How does artificial intelligence master urological board examinations? A comparative analysis of different Large Language Models' accuracy and reliability in the 2022 In-Service Assessment of the European Board of Urology.

This study is a comparative analysis of three Large Language Models (LLMs) evaluating their rate of correct answers (RoCA) and the reliability of generated answers on a set of urological knowledge-based questions spanning different levels of complexity. ChatGPT-3.5, ChatGPT-4, and Bing AI underwent two testing rounds, with a 48-h gap in between, using the 100 multiple-choice questions from the 2022 European Board of Urology (EBU) In-Service Assessment (ISA). For conflicting responses, an additional consensus round was conducted to establish conclusive answers. RoCAwas compared across various question complexities. Ten weeks after the consensus round, a subsequent testing round was conducted to assess potential knowledge gain and improvement in RoCA, respectively. Over three testing rounds, ChatGPT-3.5 achieved RoCa scores of 58%, 62%, and 59%. In contrast, ChatGPT-4 achieved RoCA scores of 63%, 77%, and 77%, while Bing AI yielded scores of 81%, 73%, and 77%, respectively. Agreement rates between rounds 1 and 2 were 84% (κ = 0.67, p < 0.001) for ChatGPT-3.5, 74% (κ = 0.40, p < 0.001) for ChatGPT-4, and 76% (κ = 0.33, p < 0.001) for BING AI. In the consensus round, ChatGPT-4 and Bing AI significantly outperformed ChatGPT-3.5 (77% and 77% vs. 59%, bothp = 0.010). All LLMs demonstrated decreasing RoCA scores with increasing question complexity (p < 0.001).In the fourth round, no significant improvement in RoCA was observed across all three LLMs. The performance of the tested LLMs in addressing urological specialist inquiries warrants further refinement. Moreover, the deficiency in response reliability contributes to existing challenges related to their current utility for educational purposes.

Identification of Correlation Between Frailty and Lower Urinary Tract Symptoms in Elderly Male Using Korean-FRAIL Scale.

The K-FRAIL scale is a Korean version of the aging questionnaire that allows screening and diagnosis of easily observable aging in the elderly through a simple self-answer questionnaire. The objective of this study was to examine the relation between fraility and clinical symptoms of the lower urinary tract in elderly men using the K-FRAIL scale. A prospective study was conducted on 100 patients who underwent urological examination at our hospital from January 2021 to December 2021. Among them, 62 patients who met the study criteria completed the following questionnaires and lower urinary tract symptoms (LUTS) parameters: K-FRAIL, International Prostate Symptom Score (IPSS), prostate specific antigen, transrectal ultrasonography, and uroflowmetry. In this cross-sectional study, we compared the K-FRAIL scale parameters with various clinical examination parameters in elderly men presenting with LUTS. We also assessed the time required to complete the scale. The age of the subjects was 66.8±5.96 years in the normal group and 71.6±9.83 years in the frail group (p=0.027). In terms of IPSS indicators, the total scores of the natural patient group and the frail patient group were 13.24±5.48 and 20.44±9.67 (p=0.001); in terms of patient serum testosterone indicators, the scores of the natural patient group and the frail patient group were 4.32±1.52 and 3.74±1.64, respectively (p=0.163). The results indicated that IPSS item 7 and serum testosterone were significant predictors (odds ratio [OR]=4.679, p=0.29; OR=0.391, p=0.043, respectively). The results of this study show that elderly men with fraility are more likely to develop nocturia and lower testosterone. When treating men with fraility, it will be helpful to know these characteristics and treat them.

Prostatic Artery Embolization as a Treatment Option for Symptomatic Benign Prostatic Hyperplasia: Results from the Prospective Follow-Up Study in Lithuania.

Background: The endovascular treatment of symptomatic benign prostate hypertrophy (BPH) by prostatic artery embolization (PAE) is one of the new treatments proposed. PAE is a minimally invasive alternative that has been shown to successfully treat lower urinary tract symptoms in BPH patients by causing infarction and necrosis of hyperplastic adenomatous tissue, which decompresses urethral impingement and improves obstructive symptoms. The aim of this study was to evaluate the effectiveness and efficacy of PAE in relieving symptoms in patients with symptomatic BPH. Materials and Methods: The material for the study was collected from 2019 to 2022. A total of 70 men with BPH and PAE were studied. Patients underwent an urological examination to measure the International Prostate Symptom Score (IPSS), Quality of Life score (QoL), International Index of Erectile Function short form (IIEF-5), uroflowmetry with Qmax, prostatic volume (PV), and post-void residual volume (PVR) measurements. Statistical analysis for dependent samples was applied. Measured parameters at 2 months and 6 months follow-up were compared to baseline. Results: At baseline, the age of the male (N = 70) subjects was 74 ± 9.6 years with a median of 73.8, but fluctuated from 53 to 90 years. The mean of PV was almost 111 mL and the Qmax was close to 7.7 mL/s. The average PVR was 107.6 mL. The IPSS score mean was 21.3 points and the QoL score was 4.53 points. The IIEF-5 questionnaire score was almost 1.8 points, which shows severe erectile dysfunction. The mean value of the PSA level was 5.8 ng/mL. After 2 and 6 months of PAE, all indicators and scores except erectile function significantly improved. Conclusions: The outcomes of our study show promising results for patients with benign prostatic hyperplasia after PAE. The main prostate-related parameters (PV, Qmax, PVR, IPSS) improved significantly 6 months after embolization.

Establishment of a new predictive model for the recurrence of upper urinary tract stones.

To construct a nomogram for evaluation of the recurrence risk of upper urinary tract stones in patients. We retrospectively reviewed the clinical data of 657 patients with upper urinary tract stones and divided them into stone recurrence group and non-recurrence group. Blood routine, urine routine, biochemical, and urological CT examinations were searched from the electronic medical record, relevant clinical data were collected, including age, BMI, stones number and location, maximum diameter, hyperglycemia, hypertension, and relevant blood and urine parameters. The Wilcoxon rank-sum test, independent sample t test, and Chi-square test were used to preliminarily analyze the data of the two groups, then LASSO and logistic regression analysis were used to find out the significant difference indicators. Finally, R software was used to draw a nomogram to construct the model, and ROC curve was drawn to evaluate the sensitivity and specificity. The results showed that multiple stones (OR: 1.832, 95% CI 1.240-2.706), bilateral stones (OR: 1.779, 95% CI 1.226-2.582), kidney stones (OR: 3.268, 95% CI 1.638-6.518), and kidney ureteral stones (OR: 3.375, 95% CI 1.649-6.906) were high risk factors. And the stone recurrence risk was positively correlated with creatinine (OR: 1.012, 95% CI 1.006-1.018), urine pH (OR: 1.967, 95% CI 1.343-2.883), Apo B (OR: 4.189, 95% CI 1.985-8.841) and negatively correlated with serum phosphorus (OR: 0.282, 95% CI 0.109-0.728). In addition, the sensitivity and specificity of the prediction model were 73.08% and 61.25%, diagnosis values were greater than any single variable. The nomogram model can effectively evaluate the recurrence risk of upper urinary stones, especially suitable for stone postoperative patients, to help reduce the possibility of postoperative stone recurrence.

Assessment of Prior Well Child Checks in Children With Concerns for Testicular Position: Opportunities for Early Referral From an Integrated Health System

To assess, through an integrated primary and specialty care pediatric health system, the association of well-child checks prior to referral with final urological diagnosis with the aim to identify opportunities for earlier referral of care STUDY DESIGN: We performed a retrospective review of children referred from primary care to urology for UDT within our integrated primary-specialty care health system in 2019, comparing children who had undescended testicles to those with either normal or retractile testicles based on the final urology examination. Demographics, including age, comorbidities, and the status of prior WCC within primary care, were reviewed. Outcomes of age at referral and surgical intervention for UDT were compared across referral categories. Stratifying by final diagnosis of 88 children included in the analysis, children with UDT were referred much later (85 months, IQR 31-113) than children without UDT on final diagnosis (33 months, IQR 15-74, p = 0.002). Furthermore, children with UDTs had a greater proportion with prior abnormal WCCs (N = 21/41, 51%) than those without UDT (N = 8/47, 17%) (P < 0.001). Children with prior abnormal WCCs were more likely to have a final diagnosis of UDT, with prior abnormalities being documented approximately 12 months prior to referral, indicating opportunities for improved referral patterns to urology.

Weiterbildung Urologie in Deutschland, Österreich und der Schweiz (DACH-Raum) unter der Lupe

Specialist titles are mutually recognized in the DACH (Germany [D], Austria [A], and Switzerland [CH]) region. During continuing education, however, there are significant differences in structure, organization and content. Organization, formalities and responsibilities, as well as admission requirements for the final examinations, in particular the examination formats in the DACH countries will be examined. In addition, these will be critically examined from the perspective of modern medical education. Documents publicly available on the Internet from the responsible authorities for continuing medical education in the DACH region were analyzed. In addition, a narrative review of the literature in medical databases on the topic of continuing medical education in urology was performed. The minimum duration of residency is 5 (D) to 6years (A, CH). Basic (surgical) training is mandatory in Austria and Switzerland. In Switzerland, the training site must be changed at least once. Part-time training is possible in all countries. Research and participation in annual congresses are mandatory only in Switzerland. Formative examinations are only required in Switzerland. In all countries, at least one summative examination is required to obtain the specialist title. In Austria and Switzerland, the written part of the European Board of Urology (EBU) examination must be passed. From a medical education perspective, Switzerland currently offers and demands the most modern elements in specialist training. The certified structured continuing education modelled on the "Deutschen Gesellschaft für Urologie" (DGU; "Weiterbildungscurriculum Urologie", WECU) in Germany integrates modern approaches in Germany. With timely implementation of, for example, entrustable professional activities (EPAs), urology in German-speaking countries could be pioneering nations and disciplines internationally.

Urinary Oxidative Stress Biomarker Levels Might Be Useful in Identifying Functional Bladder Disorders in Women with Frequency and Urgency Syndrome.

lower urinary tract dysfunctions (LUTDs) are difficult to diagnose based on symptoms. This study used a cluster of urinary biomarkers, including inflammatory cytokines, neurogenic proteins, and oxidative stress biomarkers, to identify LUTDs in women with frequency and urgency symptoms. in total, 253 women with video urodynamics (VUDS)- and cystoscopy-confirmed detrusor overactivity (DO), interstitial cystitis/bladder pain syndrome (IC/BPS), dysfunctional voiding (DV), and hypersensitive bladder (HSB), and normal controls were included. Before diagnosis and treatment, urine samples were collected for analysis of biomarkers. The urine levels of biomarkers were compared between groups with bladder dysfunctions and controls and were combined to test the sensitivity in identifying total pathological bladder diseases and specific bladder diseases. After video urodynamic study, VUDS, and urological examinations, bladder dysfunctions were classified into DO (n = 31), IC/BPS (n = 114), DV (n = 45), HSB (n = 29), and control (n = 34) groups. By using a cystomeric bladder capacity of ≤350 mL, 186/219 (84.9%) of the patients with DO, IC/BPS, DV, and HSB can be discriminated from the controls. Among these urine biomarkers, oxidative stress biomarkers 8-isoprostane, 8-hydroxydeoxyguanosine (8-OHdG), or total antioxidant capacity (TAC) are useful for identifying pathological bladder dysfunction (DO, IC/BPS, and DV) and HSB. With elevated IL-1β and lower IL-2, and elevated TNF-α levels, most patients with DV can be identified. Between DO and IC/BPS, a higher NGF level can identify 58.3% of IC/BPS cases, whereas a lower NGF level can identify 75.0% of DO cases. by using a cluster of urine biomarkers, DO, IC/BPS, and DV cases can be identified based on elevated levels of urine oxidative stress biomarkers 8-isoprostane, TAC, or 8-OHdG, and HSB cases with a low TAC. These urine biomarkers are useful for identifying specific LUTDs in women with frequency and urgency symptoms.

Urethrocystoscopy in the Urology Department of the Zinvie La Croix Hospital AU Benin: Indications and Results

Background: Urethrocystoscopy is a basic endoscopic examination in urology. The aim of this study was to describe the indications and results obtained during urethrocystoscopy in patients received and treated in the urology department of the Zinvie La Croix Hospital in Benin. Patients and methods: It was a prospective descriptive study conducted in the urology department of the Zinvie La Croix Hospital from January 1st, 2022 to July 30th, 2022, involving 92 patients. The variables studied were: age, sex, indication for urethrocystoscopy and results obtained. Results: Of the 92 patients collected, there were 72 men (78.2%) and 20 women (21.7%); the sex ratio was 3.6. The age of the patients ranged from 16 to 80 years with an average of 43.43 years; 48.8% of the patients were under 40 years of age and the age group (20-39 years) represented 43.4%. The main indications were lower urinary tract symptoms (48.57%) followed by hematuria (19.04%). The main results were bladder neck sclerosis 14 (17.28%) and urethral stricture 13 (16.04%) in men and urinary bilharzia 8 (40%) and bladder tumor 4 (20%) in women. Conclusion: Urethrostoscopy is a primary examination in urology. Lower urinary tract symptoms were the main indication; bladder neck sclerosis in men and urinary bilharzia in women were the main pathologies encountered. This technique should be popularized in urological outpatient surgery.