Urologic Health Research Articles

The Crosstalk between Prostate Cancer and Microbiota Inflammation: Nutraceutical Products Are Useful to Balance This Interplay?

The human microbiota shows pivotal roles in urologic health and disease. Emerging studies indicate that gut and urinary microbiomes can impact several urological diseases, both benignant and malignant, acting particularly on prostate inflammation and prostate cancer. Indeed, the microbiota exerts its influence on prostate cancer initiation and/or progression mechanisms through the regulation of chronic inflammation, apoptotic processes, cytokines, and hormonal production in response to different pathogenic noxae. Additionally, therapies’ and drugs’ responses are influenced in their efficacy and tolerability by microbiota composition. Due to this complex potential interconnection between prostate cancer and microbiota, exploration and understanding of the involved relationships is pivotal to evaluate a potential therapeutic application in clinical practice. Several natural compounds, moreover, seem to have relevant effects, directly or mediated by microbiota, on urologic health, posing the human microbiota at the crossroad between prostatic inflammation and prostate cancer development. Here, we aim to analyze the most recent evidence regarding the possible crosstalk between prostate, microbiome, and inflammation.

Lower Urinary Tract Symptoms: Advances in Women's Urologic Health From MAPP and LURN

Urinary tract conditions causing urinary symptoms, including pain and discomfort, are common in women of all ages. Lower urinary tract symptoms (LUTS) are highly prevalent with 59.2% of women exhibiting storage symptoms; 19.5% exhibiting voiding symptoms; and 14.2% exhibiting postmicturition symptoms and the prevalence of symptoms increases with age.1 Lower urinary tract pain, in particular, appears to be a problem more common in women than men.1 Unfortunately, many patients who seek care for LUTS experience neither total nor permanent resolution of their symptoms with current management approaches.

PD14-07 ASSOCIATION OF SOCIOECONOMIC FACTORS WITH REPEAT STONE SURGERY: DATA FROM THE REGISTRY FOR STONES OF THE KIDNEY AND URETER

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (PD14)1 Apr 2020PD14-07 ASSOCIATION OF SOCIOECONOMIC FACTORS WITH REPEAT STONE SURGERY: DATA FROM THE REGISTRY FOR STONES OF THE KIDNEY AND URETER Amy Showen*, David Bayne, Justin Ahn, Manuel Armas-Phan, Marshall Stoller, and Thomas Chi Amy Showen*Amy Showen* More articles by this author , David BayneDavid Bayne More articles by this author , Justin AhnJustin Ahn More articles by this author , Manuel Armas-PhanManuel Armas-Phan More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000848.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urolithiasis affects 1 in 11 Americans, and is associated with annual health care expenditures of up to $4.5 billion. Undergoing multiple as opposed to single procedures for urolithiasis confers additional risk to the patient and additional cost to the health care system. Both demographic characteristics (age <60 years, female gender) and clinical factors (malabsorption, diabetes, recurrent urinary tract infections, personal history of nephrolithiasis, and bilateral stones) predict undergoing multiple procedures. We aimed to determine socioeconomic factors (beyond age and gender) associated with repeat stone surgery. METHODS: We reviewed prospectively collected data from the Registry for Stones of the Ureter and Kidney (ReSKU) from 2015 to 2018. Patients ≥18 years with urolithiasis requiring procedural intervention and complete data were included. Socioeconomic variables of interest included race, education, language, mean income in zip code of residence, and healthcare access metrics (distance from tertiary care, urologist density in county of residence). The primary outcome was repeat surgery within 180 days of an index procedure for urolithiasis. Each socioeconomic variable was entered separately into a logistic regression model adjusted for age and gender. RESULTS: Complete data was available for 317 of 500 patients who underwent one or more procedures for urolithiasis. Of these 317 patients, 275 (87%) patients underwent a single procedure, and 42 patients (13%) underwent multiple procedures (Table 1). After controlling for age and gender, lower income and urologist density were associated with repeat surgery (p<0.05, Table 2). CONCLUSIONS: Our findings contribute to growing evidence for social determinants of urologic health. Conceptually, lower income and urologist density may impede timely access to high-quality urologic care, resulting in large or complex stones that require multiple procedures. From equity and cost perspectives, more research on the social determinants of urolithiasis is needed. Source of Funding: NIH grant P20-DK-116193 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e274-e275 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amy Showen* More articles by this author David Bayne More articles by this author Justin Ahn More articles by this author Manuel Armas-Phan More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement PDF downloadLoading ...

Standardized Office Cystoscopy Training for Advanced Practice Providers in Urology.

Cystoscopy is one of the most commonly performed urological procedures. Indications include evaluation of hematuria and bladder cancer monitoring, which requires frequent surveillance for management. The challenges of maintaining the urology workforce are well-documented, and alternative options should be developed for performing cystoscopy safely and effectively. Nurse practitioners and physician assistants (ie advanced practice providers) are established professionals who have provided urological care for decades and who could acquire the necessary procedural skills following establishment of practice guidelines. Review and synthesis of the available world literature were completed to form an evidence-based proposal for a flexible cystoscopy training curriculum targeted to advanced practice providers in outpatient urology care settings. Of 49 primary sources 10 were appropriate for evaluation, resulting in development of clinical and technical knowledge domains for training U.S. based advanced practice providers in cystoscopy. Skills checklists were developed to aid in training, evaluation and privileging. Based on analysis of the existing literature, we propose a framework for standardizing outpatient flexible cystoscopy training for U.S. based advanced practice providers. Adoption of this framework will establish the standards necessary to ensure high quality, reproducible outcomes essential for seamlessly integrating advanced practice providers into this procedural role within the urological health care team.

FR02-04 UROLOGIC HEALTH THROUGHOUT THE HISTORY OF THE WHITE HOUSE

INTRODUCTION AND OBJECTIVES:The urologic health of US presidents and their first ladies has not been thoroughly studied. We sought to examine the incidence and patterns of urologic diseases among f...

The relationship between cannabis and male infertility, sexual health, and neoplasm: a systematic review.

In the United States of America (USA), cannabis is legal in 28 states for medical purposes and 8 states for recreational use. In 2016, the legal marijuana industry reached nearly $7 billion in sales in the USA alone. Although consumption continues to increase, the medical effects of marijuana remain understudied. Young males comprise the demographic most likely to consume cannabis, and these individuals will be most vulnerable to its short- and long-term consequences. The purpose of this manuscript is to systematically review the available literature describing the effects of marijuana on male infertility, sexual health, and urologic neoplasms. A comprehensive literature search was conducted using the Medline and Embase databases through May 2017. In vitro models, animal models, case series, case-control, and cohort designs were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was utilized to report results. After exclusions, 91 articles were synthesized for qualitative analysis. Of these manuscripts, 30 pertained to marijuana and male infertility, 36 discussed cannabis and male sexual health/hormones, and 25 explored the relationship between marijuana and urologic neoplasms. With respect to male factor fertility using semen parameters as a surrogate, cannabinoids likely play an inhibitory role. Data on marijuana and male sexual function are mixed but suggest that marijuana may enhance the subjective experience of sexual intercourse while potentially contributing to ED in a dose-dependent manner. Cannabis has been associated with both increased and decreased risk of malignancy depending upon the target organ. Marijuana exposure seems to be an independent risk factor for testis cancer, data on bladder cancer are conflicting, and the evidence on prostate cancer supports anti-neoplastic effects of cannabinoids. Studies of the effects of cannabis suggest impact on urologic health and disease. Prospective, long-term studies are necessary for further elucidation of these effects.

Overcoming Barriers in Conducting a Transatlantic Prostate Cancer Familial Study in Africa: Best Practice From the CaPTC Cohort Study

Background: Collection of data concerning men's health generally and urological health particularly has always had its challenges, especially in the African setting. Some of the difficulties stem from cultural factors that consider sensitive topics pertaining to men's health as taboo. Aim: To determine how to overcome barriers in conducting a transatlantic prostate cancer familial study in Africans. Methods: After the first phase of the TRANSATLANTIC PROSTATE CANCER FAMILIAL PROJECT STUDY, a survey was carried out among the data collectors and principal investigators using Qualtrix software to collect qualitative feedback on the study. The data from the survey was analyzed using SPSS version 18. Results: Presently, 625 people are enrolled for the study and more are waiting to be recruited in the next phase. About 73% of the participants requested a home or office visit rather than visit a data collection center. On the average, the questionnaire required an average of two hours of personal interview rather than the one hour that had been envisaged. However the participants declared that participant incentives were well worth it. 80% of the participants had no preference for interviewer gender. 80% of the interviewers agreed that answers to questions about participants' sexuality were most difficult to obtain but with an in-depth explanation of the importance of the study and assurance of privacy, the answers were obtained. About 46% of the participants requested that their results be typed and given to them personally, 21% requested results be sent as to them as text messages while 26% requested general results of the study be made available to them in form of booklets, flyers and orally in town hall meetings. Conclusion: The TRANSATLANTIC PROSTATE CANCER FAMILIAL PROJECT STUDY survey questionnaire is a very workable tool that has a high acceptance rate among participants. The best practice for engaging the community for research include community mobilization through sensitization visits and one-on-one talks, use of community 'gatekeepers', introduction by relatives, assurance of privacy of health data obtained, the use of incentives and a promise to give feedback on the results of the study both on a personal and community level.

Supportive interventions to improve physiological and psychological health outcomes among patients undergoing cystectomy: a systematic review

BackgroundOur understanding of effective perioperative supportive interventions for patients undergoing cystectomy procedures and how these may affect short and long-term health outcomes is limited.MethodsRandomised controlled trials involving any non-surgical, perioperative interventions designed to support or improve the patient experience for patients undergoing cystectomy procedures were reviewed. Comparison groups included those exposed to usual clinical care or standard procedure. Studies were excluded if they involved surgical procedure only, involved bowel preparation only or involved an alternative therapy such as aromatherapy. Any short and long-term outcomes reflecting the patient experience or related urological health outcomes were considered.ResultsNineteen articles (representing 15 individual studies) were included for review. Heterogeneity in interventions and outcomes across studies meant meta-analyses were not possible. Participants were all patients with bladder cancer and interventions were delivered over different stages of the perioperative period. The overall quality of evidence and reporting was low and outcomes were predominantly measured in the short-term. However, the findings show potential for exercise therapy, pharmaceuticals, ERAS protocols, psychological/educational programmes, chewing gum and nutrition to benefit a broad range of physiological and psychological health outcomes.ConclusionsSupportive interventions to date have taken many different forms with a range of potentially meaningful physiological and psychological health outcomes for cystectomy patients. Questions remain as to what magnitude of short-term health improvements would lead to clinically relevant changes in the overall patient experience of surgery and long-term recovery.

Endocrine disruptor bisphenol A is implicated in urinary voiding dysfunction in male mice.

Estrogens, acting synergistically with androgens, are known from animal experiments to be important in lower urinary tract symptoms (LUTS) and benign prostate enlargement. Human exposure to environmental estrogens occurs throughout the life span, but the urologic health risks in men are largely unknown. Bisphenol A (BPA) is an endocrine disruptor implicated in male urogenital malformations. Given the role of estrogens in male LUTS, we studied the effects of BPA administered in combination with testosterone (T) on the urinary voiding behavior of adult male mice. Adult male mice underwent subcutaneous implantation with slow-release pellets of 25 mg BPA or 2.5 mg estradiol-17β (E2), plus 25 mg T, and were compared with untreated (UNT) mice that underwent sham surgery. We studied urinary voiding behavior noninvasively for 1 mo before treatment and for 4 mo after treatment. After euthanasia, we evaluated bladder volume and mass. Mice treated with T+BPA had increased bladder volume ( P < 0.05) and mass ( P < 0.01) compared with UNT mice. After 4 mo of treatment with T+BPA, three of five mice developed voiding dysfunction in the form of droplet voiding or an intermediate pattern of voiding different from both UNT and T+E2-treated mice. Treatment of male mice with BPA or estradiol induces voiding dysfunction that manifests at later time points, implicating the endocrine disruptor, BPA, as a contributor to male LUTS.

К 70-летию урологической службы Алтайского края

К 70-летию урологической службы Алтайского края

Author Reply

We appreciate the reviewer's supportive comments. As they stated, identifying a bidirectional causality between systemic and urologic disease states would be novel and extraordinarily impactful. Doing this in a statistically valid way would likely be in the realm of big data. Our more modest goal is focused on the ability to counsel patients on the likelihood of meaningful impact of our urologic therapies in the context of their broader systemic health. A transurethral resection of prostate may not help urinary frequency in an uncontrolled diabetic on high dose diuretics. Testosterone replacement may not help fatigue in untreated sleep apnea. Engaging the patient in their medical care to improve their urologic symptoms may be aided by the use of the anxiety, cardiovascular, testosterone deficiency, insulin (diabetes), obesity, neurologic, and sleep apnea phenotype. Similarly, we hope that the urologic community sees their time with male patients as an opportunity to improve their general health in addition to their urologic health. The urologic conditions studied in this paper affect quality of life not quantity of life in a direct manner. Quality of life impact is an impetuous for patients to seek medical care, therefore the urologist may serve as a gatekeeper for patients, particularly when they are young and their systemic conditions are modifiable.

The Relationship Between Shift Work and Men's Health.

More than 21 million Americans and nearly 20% of the U.S. workforce are shift workers. Non-standard shift work, defined as work that falls outside of 6 am-6 pm, can lead to poor diet, exercise, and sleep habits that lead to decreased productivity, increased workplace accidents, and a variety of negative health outcomes. To investigate the associations between shift work exposure and chronic medical conditions such as metabolic syndromes, cardiovascular disease, gastrointestinal disturbances, and depression as well as urologic complications including hypogonadism, male infertility, lower urinary tract symptoms, and prostate cancer with a focus on the effects of shift work sleep disorder (SWSD) on the severity of these negative health outcomes. We reviewed the literature examining effects of shift work and SWSD on general and urologic health. We produced a summary of effects of shift work on health with focus on the increased risk of negative health outcomes in non-standard shift workers, particularly those with SWSD, when compared to daytime workers or workers without SWSD. Studies have associated non-standard shift work schedules and poor health outcomes, including increased risks of diabetes mellitus, dyslipidemia, hypertension, heart disease, peptic ulcer disease, and depression, in shift workers. However, few studies have focused on the role that shift work plays in men's urologic health. Current evidence supports associations between non-standard shift work and increased hypogonadal symptoms, poor semen parameters, decreased fertility, lower urinary tract symptoms, and prostate cancer. These associations are strengthened by the presence of SWSD, which affects up to 20% of shift workers. Unfortunately, interventions, such as planned naps, timed light exposure, melatonin, and sedative hypnotics, aimed at alleviating excessive nighttime sleepiness and daytime insomnia in non-standard shift workers experiencing SWSD, are limited and lack strong evidence to support their efficacy. Non-standard shift work has been associated with a variety of negative health outcomes and urologic complications, especially with concurrent SWSD. Recognition of these increased risks among shift workers can potentially aid in more effective screening of chronic health and urologic conditions. Non-pharmacologic treatment of SWSD focuses on behavioral therapy and sleep hygiene while melatonin, hypnotics, and stimulants are used to alleviate insomnia and excessive sleepiness of SWSD. Further research into both pharmacologic and non-pharmacologic therapies for SWSD is needed to establish more definitive guidelines in the treatment of SWSD in order to increase productivity, minimize workplace accidents, and improve quality of life for shift workers. Deng N, Kohn TP, Lipshultz LI, etal. The Relationship Between Shift Work and Men's Health. Sex Med Rev 2018;6:446-456.

Model of a patient-centered system of urological health care using eHealth technologies

Model of a patient-centered system of urological health care using eHealth technologies

The Neurogenic Bladder Symptom Score (NBSS): a secondary assessment of its validity, reliability among people with a spinal cord injury.

Prospective cross-sectional study. Validate the Neurogenic Bladder Symptom Score (NBSS) for people with spinal cord injury (SCI). United States (recruitment from community/tertiary neurourology clinics). We used data from a prospective observational study of people with a SCI who enrolled during December 2015-September 2016. Participants completed the NBSS and other measurement tools (SF-12 and SCI-QOL Bladder Management Complications tool). Data were used to determine the internal consistency (Cronbach's alpha), validity (hypothesis testing), and test-re-test reliability (using an intraclass correlation coefficient). 609 people with a SCI had complete data. The median NBSS total score was 22 (IQR 15-30), and median quality of life was "mixed". The Cronbach's alpha of the total and the incontinence, storage/voiding, and consequences domains was 0.85, 0.93, 0.76, and 0.49 respectively. All item to domain correlations were ≥0.3, aside from 3/7 of the items from the consequences domain. Appropriate correlations between the NBSS domains and external variables and other questionnaires were observed, such as a moderate correlation between the SCI-QOL Bladder Management complications tool and the NBSS total score. For the reliability assessment, 174 people had 3 month followup data and did not have a significant change to their urologic health. The intraclass correlation coefficients were >0.75 for all subdomains and the overall score. The NBSS demonstrated good validity and reliability in a large cohort of people with a SCI, and is a suitable tool to assess neurogenic bladder symptoms. Patient-Centered Outcomes Research Institute (PCORI) Award CER14092138.

Ultrasound and the Complete Urologist Part 2: Outcomes

Outcome studies help establish the benefits of tests or procedures that can change the delivery of medical care. Through this discourse, the current status of outcomes with respect to the use of ultrasound imaging for AMH as well as its general use during a routine urologic physical examination are explored. The changes in today's health care environment focus on cost reduction and outcomes that produce value in the context of patient satisfaction. The question is whether we have to wait for outcome results (that can take a lengthy period of time to achieve) before the benefits produced by ultrasound can be applied. This report reviews the literature and the role ultrasound can play in today's urologic health care environment. Supportive evidence demonstrates the value that ultrasound use brings to the urologic examining table for AMH and to daily urologic practice to the benefit of both patient and physician.

Preface to the human microbiome in urologic health and disease.

We are very pleased to present this special issue of the Annals of Translational Medicine , “The Human Microbiome in Urologic Health and Disease.” This issue developed from the Basic Science Symposium of the same name sponsored by the American Urological Association (AUA) Office of Research at the Annual meeting of the AUA on May 6, 2016. Speakers who presented at that symposium comprise the invited authors for this issue.

How Readable Is BPH Treatment Information on the Internet? Assessing Barriers to Literacy in Prostate Health.

Information about benign prostatic hyperplasia (BPH) has become increasingly accessible on the Internet. Though the ability to find such material is encouraging, its readability and impact on informing patient decision making are not known. To evaluate the readability of Internet-based information about BPH in the context of website ownership and Health on the Net certification, three search engines were queried daily for 1 month with BPH-related keywords. Website ownership data and Health on the Net certification status were verified. Three readability analyses were performed: SMOG test, Dale–Chall readability formula, and Fry readability graph. An adjusted SMOG calculation was performed to reduce overestimation from medical jargon. After a total of 270 searches, 52 websites met inclusion criteria. Mean SMOG grade was 10.6 (SD = 1.4) and 10.2 after adjustment. Mean Dale–Chall score was 9.1 (SD = 0.6), or Grades 13 to 15. Mean Fry graph coordinates (173 syllables, 5.1 sentences) corresponded to Grade 15. Seven sites (13%) were at or below the average adult reading level based on SMOG; none of the sites qualified based on the other tests. Readability was significantly poorer for academic versus commercial sites and for Health on the Net-certified versus noncertified sites. In conclusion, online information about BPH treatment markedly exceeds the reading comprehension of most U.S. adults. Websites maintained by academic institutions and certified by the Health on the Net standard have more difficult readability. Efforts to improve literacy with respect to urological health should target content readability independent of reliability.

How successful is the transition to adult urology care in spina bifida? A single center 7-year experience

Rates of successful transition from adolescent to adult spina bifida (SB) care are unknown. We aimed to assess rates and predictors of successful transition from a multidisciplinary SB clinic to a transitional urology clinic (TUC), or a pediatric or adult urologist. We retrospectively reviewed patients discharged from a multidisciplinary SB clinic (2006-2012), collecting demographic and clinical data. At transition, all patients/families were given instructions to arrange an appointment within 12 months. Patients who followed-up within 2 years were classified as transitioned. Logistic regression was used for analysis. Of 77 patients discharged at a mean age of 19.1 years, 31 (40.3%) successfully transitioned (mean follow-up 4.7 years). Only 20/41 (48.8%) with prior bladder augmentation, urinary channel, and MACE transitioned. There was no significant change in patients transitioning over time or late catch-up presentations (p=0.41 see Figure). Transitioned and non-transitioned groups were similar in age, gender, home-to-clinic distance, insurance, ambulation, shunt status, prior non-adherence, emergency room visits, neurosurgery appointments, hospitalizations, and surgeries (including genitourinary reconstruction) before discharge (p=0.22). Transitioned patients had more pre-discharge appointments with services outside the SB clinic (p=0.01) and radiographic studies (p<0.001), but these were not significant on multivariate analysis (p=0.16). Among those who did not transition, five (6.5%) presented after 2 years, rarely with new complaints (20.0%). Patients without urological follow-up were most likely to visit the emergency room (p=0.03). To facilitate continued care and a smooth transition, the TUC was opened across the corridor from the multidisciplinary SB clinic. To our surprise, a low percentage of patients actually transitioned to adult care over the last 7 years. It is a sobering fact that despite offering three different transition models, <50% of patients took advantage of any of them. While none of the predictors we anticipated to be important in a successful transition were statistically significant, potentially because of low statistical power, perhaps others, such as insufficient time to coordinate care, wait times, and lack of adult coordinated care programs, may be more important. We were unable to compare the urologic health of those who did and did not transition, as we relied on medical record data. Only 40% of patients transitioned successfully from a multidisciplinary SB clinic and few presented after 2 years. Patients who transitioned tended to have more active health issues and more radiographic tests prior to discharge. Those followed by a urologist are less likely to use emergency room services.

Expert Panel Recommendations on Lower Urinary Tract Health of Women Across Their Life Span.

Urologic and kidney problems are common in women across their life span and affect their daily life, including physical activity, sexual relations, social life, and future health. Urological health in women is still understudied and the underlying mechanisms of female urological dysfunctions are not fully understood. The Society for Women's Health Research (SWHR®) recognized the need to have a roundtable discussion where researchers and clinicians would define the current state of knowledge, gaps, and recommendations for future research directions to transform women's urological health. This report summarizes the discussions, which focused on epidemiology, clinical presentation, basic science, prevention strategies, and efficacy of current therapies. Experts around the table agreed on a set of research, education, and policy recommendations that have the potential to dramatically increase awareness and improve women's urological health at all stages of life.

Impact of branding on public awareness of healthcare-related governing bodies: a pilot study of the Urological Society of Australia and New Zealand brand.

To assess the general public's understanding of urologists and of the Urological Society of Australian and New Zealand (USANZ) and gauge the effectiveness with which the USANZ disseminates health information about urological conditions to health consumers. Using prostate cancer as an example, a Qualtrics online market survey of Australian healthcare consumers recruited from an online pool was conducted. The number of districts sampled within each state or territory was proportional to the size of the target population within each region and were proportionately distributed across metropolitan and non-metropolitan areas. Demographic characteristics were comparable with the Australian Bureau of Statistics Census figures corresponding to the target age group. The survey assessed knowledge of the roles of medical specialties through open-ended responses to qualitative items, association tasks, and recall/recognition questions. Subjects were asked to rate their familiarity of medical specialists and of six medical specialty logos. There were 302 respondents. Subjects indicated less awareness of urology vs other medical specialties, were relatively unaware that urologists were concerned with the prostate, and the USANZ branding was among the least familiar (P < 0.001, Friedman test). When asked the first medical specialist that came to mind when told of prostate cancer, only 22% wrote urologist. The general public has a limited understanding of urologists and of the USANZ. Sub-brand names that explicitly link urologists to urological conditions, has been suggested as a means to increase the public's understanding of urologists and of the USANZ, and improve the USANZ's ability to promulgate urological health information.