Weak Stream Research Articles

Transabdominal Ultrasonographic Evaluation of Enlarged Prostate with Histopathological Comparison

Introduction: The prostate is an accessory gland of the male reproductive system. It can be involved by a number of diseases ranging from inflammation to malignant diseases. Most common causes of prostatomegaly are benign prostatic hyperplasia, prostatitis, intraprostatic and periprostatic cyst, prostatic adenocarcinoma. Objectives: To evaluate the diagnostic usefulness of Transabdominal ultrasonography in enlarged prostate and compare the USG findings with the histopathological findings. Method: This cross sectional study was carried out in Radiology and Imaging Department of Sir Salimullah medical college and Mitford hospital, Dhaka, from January 2014 to December 2015 with clinically suspected enlarged prostate by department of Urology and referred to the Radiology and Imaging Department for proper evaluation whether benign or malignant by Trans-abdominal ultrasonography before treatment planning and further management. Results: In this study, mean age was 65. 8 years with standard deviation of mean ± 9. 7 years and the age ranged from 50 to 89 years. The most common symptoms associated with enlarged prostate were incomplete emptying 90%, frequency 84%, intermittency 80% urgency, 76%, weak stream, 70% straining 66%, nocturia 60%. Out of 50 patients, histopathological diagnosis of 44 (88%) was nodular hyperplasia, 2 (4%) was nodular hyperplasia with chronic prostatitis and rest of 4(8%) was adenocarcinoma of prostate. Conclusion: Ultrasonography is a non-invasive, available, radiation free procedure, which is used as a first line preliminary diagnostic procedure.

Urodynamic Curve Patterns may Predict Female Bladder Outlet Obstruction and Detrusor Underactivity

To search for independent predictors for distinguishing bladder outlet obstruction (BOO) and detrusor underactivity (DU) in female patients with voiding difficulty. A retrospective patient file review was performed of 918 female patients with lower urinary tract symptoms. After exclusion criteria, 148 patients with voiding difficulty were eligible for the study. Patients were classified as having BOO and DU based on urodynamic BOO and DU definitions. The symptoms, patient characteristics, the patterns of free urine flow, and detrusor voiding pressure curves were compared between 2 groups. Of 148 patients with a median age of 53 (18-86), 42 (28,4%), 37 (25%), 69 (46,6%) patients had a urodynamic diagnosis of BOO, DU, and unclassified P/F study respectively. Multivariate logistic regression analysis results showed that the symptom of weak urine stream [P=.015 OR=7.07 CI(1,47-34,0)], the negative provocative stress test [P=.038 OR=7.32 CI(1,12-47,83)], the continuous detrusor voiding pressure and the prolonged/tailed shaped free urine flow curve patterns [P < .001 OR=2,99 CI(1,66-5,38)] were the independent predictors of BOO. Sensitivity and specifity values for prolonged/tailed to predict BOO were 82.5 and 60% respectively. The continuous detrusor voiding pressure and the prolonged/tailed shaped free urine flow curve patterns were found to be useful independent predictors for distinguishing BOO from DU in female patients with voiding difficulty. In addition, the symptom of weak urine stream, and the negative provocative stress test may be of beneficial use.

Diagnosis, management, and outcome of urethral obstruction secondary to the capsule associated with the artificial urethral sphincter device.

BackgroundUrethral obstruction secondary to artificial urethral sphincter (AUS) implantation is a recognized complication in dogs. However, urethral obstruction secondary to AUS‐associated capsule formation has been described rarely.HypothesisDescribe clinical and diagnostic findings, management, and outcome in 6 dogs with urethral obstruction secondary to AUS‐associated capsule formation.AnimalsSix client‐owned dogs.MethodsRetrospective study. Medical records between January 1, 2010, and June 30, 2021, were reviewed to identify dogs with urethral obstruction associated with the AUS device.ResultsThe AUS device was implanted a median of 884 days (range, 20‐2457 days) before presentation for urethral obstruction. Median age at time of urethral obstruction was 4.7 years (range, 3.1‐8.7 years). Clinical signs at the time of urethral obstruction were stranguria (n = 4), pollakiuria (3), weak urine stream (2), and worsened urinary incontinence (1). In all dogs, the urethra was noted to be stenotic during urethroscopy and positive contrast cystourethrography. All dogs underwent surgery, and a fibrous capsule associated with the AUS was found to be causing urethral stenosis. Resolution of urethral obstruction occurred in all dogs after transection or removal of the capsule. Positive bacterial cultures were obtained from the capsule, AUS, or both in all dogs. Recurrence of urethral obstruction had not occurred in any dog at the time of follow‐up.Conclusions and Clinical ImportanceUrethral obstruction secondary to capsule formation is an uncommon but clinically important complication associated with use of the AUS. Continued investigation is needed to evaluate this complication more thoroughly, and its possible association with infection.

Sleep and Autonomic Manifestations in Parkinson's Disease Complicated With Probable Rapid Eye Movement Sleep Behavior Disorder.

Patients with Parkinson’s disease (PD) complicated with rapid eye movement sleep behavior disorder (RBD) present with distinct clinical features. The purpose of this study was to determine the clinical features of sleep and autonomic symptoms in PD patients with probable RBD (pRBD). The study included 126 patients with PD. pRBD was defined as having a history of dream-enacting behavior with a total score of 5 or greater on the Japanese version of the RBD Screening Questionnaire (RBDSQ-J). The Parkinson’s Disease Sleep Scale-2 (PDSS-2) was used to evaluate sleep disturbances. Scales for Outcomes in Parkinson’s Disease-Autonomic dysfunction (SCOPA-AUT) were used to evaluate autonomic symptoms. Clinical assessments included disease severity, motor symptoms, olfaction, depression, cognitive function, levodopa equivalent dose (LED), and cardiac metaiodobenzylguanidine (MIBG) scintigraphy. Correlations between RBDSQ-J total scores and clinical variables were analyzed. Compared to PD patients without pRBD, PD patients with pRBD showed severe hyposmia, severe sleep-related symptoms, severe dysautonomia, and more reduced cardiac MIBG scintigraphy. Within the PDSS-2, the “PD symptoms at night” domain was significantly more severe in PD patients with pRBD. Within the SCOPA-AUT, the “urinary” and “cardiovascular” domains were significantly higher in PD patients with pRBD. In correlation analyses, RBDSQ-J total scores were positively correlated with PDSS-2 total scores, “PD symptoms at night” and “disturbed sleep” domains, Epworth Sleepiness Scale scores, SCOPA-AUT total scores, “urinary,” “cardiovascular,” and “thermo” domain scores, and LED. RBDSQ-J total scores were negatively correlated with cardiac MIBG scintigraphy uptake. Binary logistic regression analysis showed that PDSS-2 subitem 7 (distressing hallucinations) and SCOPA-AUT subitem 11 (weak stream of urine) were significant determinants for pRBD. Our study showed that PD patients with pRBD had characteristic sleep and autonomic symptoms.

Defining Success after Anterior Urethroplasty: An Argument for a Universal Definition and Surveillance Protocol.

A successful urethroplasty has been defined in different ways across studies. This variety in the literature makes it difficult to compare success rates and techniques across studies. We aim to evaluate the success of anterior urethroplasty based on different definitions of success in a single cohort. Data were collected from a multi-institutional, prospectively maintained database. We included men undergoing first-time, single-stage, anterior urethroplasty between 2006 and 2020. Exclusion criteria included lack of followup, hypospadias, extended meatotomy, perineal urethrostomy, posterior urethroplasty and staged repairs. We compared 5 different ways to define a "failed" urethroplasty: 1) stricture retreatment, 2) anatomical recurrence on cystoscopy, 3) peak flow rate <15 ml/second, 4) weak stream on questionnaire and 5) failure by any of these measures. Kaplan-Meier survival curves were generated for each of the definitions. We also compared outcomes by stricture length, location and etiology. A total of 712 men met inclusion criteria, including completion of all types of followup. The 1- and 5-year estimated probabilities of success were "retreatment," 94% and 75%; "cystoscopy," 88% and 71%; "uroflow," 84% and 58%; "questionnaire," 67% and 37%; and "any failure," 57% and 23%. This pattern was inconsistent across stricture length, location and etiology. The estimated probability of success after first-time, anterior urethroplasty is highly dependent on the way success is defined. The variability in definitions in the literature has limited our ability to compare urethroplasty outcomes across studies.

A Case Report to Study The Effective Role of Varunadi Kashaya and Dashmool Churna in the Causes of Increased Post Void Residual Urine

Post-Void Residual (PVR) volume of urine is the amount of urine retained in the bladder after a voluntary void that is measured by catheterization or non-invasively by ultrasonography. The increased value of PVR act as a diagnostic tool in a urological pathology such as a neurological disease/injury to the bladder, mechanical obstruction, infection or medication induced urinary retention. A PVR less than 50ml signifies adequate bladder emptying. The present case is of 3.1mm non-obstructing left renal calculus and Grade III prostatomegaly with increased Post Void Residual urine (91ml). Renal calculi and prostatomegaly, both are common obstructive uropathies which interferes with the normal outflow of urine. Treatment is aimed at relieving the symptoms and to treat the underlying cause as well. The treatment strategies that can be followed are catheterization, stenting, surgery, lithotripsy, hormonal therapy and antibiotic therapy. The Ayurvedic formulation, Varunadi Kashaya and Dashmool Churna are Vata kapha pacifying drugs. With its Mutrala, Deepana, Anulomana, Shothghana, Shoolghana properties, it had successfully eliminated renal calculus, decreased the prostate size and ultimately, lowered the PVR value as evidenced in USG report. There is a considerable relief in the troublesome urological symptoms- dysuria, dribbling micturition, weak urine stream, inadequate bladder emptying and abdominal pain.

Integration-based extraction and visualization of jet stream cores

Abstract. Jet streams are fast three-dimensional coherent air flows that interact with other atmospheric structures such as warm conveyor belts (WCBs) and the tropopause. Individually, these structures have a significant impact on the midlatitude weather evolution, and the impact of their interaction is still a subject of research in the atmospheric sciences. A first step towards a deeper understanding of the meteorological processes is to extract the geometry of jet streams, for which we develop an integration-based feature extraction algorithm. Thus, rather than characterizing jet core line purely as extremal line structure of wind magnitude, our core-line definition includes a regularization to favor jet core lines that align with the wind vector field. Based on the line geometry, proximity-based filtering can automatically detect potential interactions between WCBs and jets, and results of an automatic detection of split and merge events of jets can be visualized in relation to the tropopause. Taking ERA5 reanalysis data as input, we first extract jet stream core lines using an integration-based predictor–corrector approach that admits momentarily weak air streams. Using WCB trajectories and the tropopause geometry as context, we visualize individual cases, showing how WCBs influence the acceleration and displacement of jet streams, and how the tropopause behaves near split and merge locations of jets. Multiple geographical projections, slicing, as well as direct and indirect volume rendering further support the interactive analysis. Using our tool, we obtained a new perspective on the three-dimensional jet movement, which can stimulate follow-up research.

Patient-Friendly Summary of the ACR Appropriateness Criteria: Lower Urinary Tract Symptoms-Suspicion of Benign Prostatic Hyperplasia.

Men who suffer lower urinary tract symptoms (LUTS) such as incontinence or problems urinating may have benign prostatic hyperplasia (BPH), or enlargement of the prostate gland. An enlarged prostate gland may result in abnormal bladder function by causing bladder outlet obstruction, ultimately resulting in LUTS. LUTS may include a slow or weak urine stream, hesitancy in releasing urine, difficulty in emptying the bladder, and needing to get up at night to urinate.

Detailed Analysis of Exergy Destruction of All Basic Types of Heat Exchangers

Dimensionless expressions of exergy destruction, normalized to ambient temperature and heat capacity of the weaker stream, for all basic types of recuperators are derived. The analytical expressions for maximum exergy destruction were calculated using the GNU Octave software for all recuperators, namely parallel-flow and counter-flow recuperators, and all forms of cross-flow heat exchangers, namely without mixing of streams, only mixing the streamlines of the weaker stream, only mixing the streamlines of the stronger stream and mixing the weaker and stronger streams. For parallel-flow and counter-flow recuperators, as well as for their special cases, expressions for local and total exergy destruction are given. It is shown that the maximum exergy destruction, as a local extreme, is the same for all recuperators for mutually equal values of the quantities π3 (ratio of the heat capacity of the weaker stream to the heat capacity of the stronger stream) and πT (ratio of the inlet temperature of the stronger stream to the inlet temperature of the weaker stream). The ratio of exergy destruction to effectiveness of each basic type of recuperator is further analyzed. The obtained results are presented and interpreted in appropriate dimensionless diagrams.

Impact of sacrocolpopexy for the management of pelvic organ prolapse on voiding dysfunction and uroflowmetry parameters: a prospective cohort study.

Voiding difficulties in the context of pelvic organ prolapse are often neglected or underestimated. To date, there are heterogeneous data available on the outcome of a surgical correction of pelvic organ prolapse and the impact on concomitant voiding dysfunction. The primary aim of this study was to evaluate whether laparoscopic sacrocolpopexy would resolve preoperative voiding dysfunction and the impact on objective uroflowmetry parameters. Data from 103 women undergoing sacrocolpopexy for prolapse stage ≥ II with concurrent objective and/or subjective voiding dysfunction were prospectively evaluated. All women underwent full urogynecological examination, and completed a validated questionnaire pre- and postoperatively. Objective uroflowmetry parameters and subjective outcome data regarding voiding functions were compared pre- and postoperatively. All points of the POP-Q system improved significantly pre- to postoperatively (p < 0.001). Preoperatively, 42 of 103 women showed a postvoid residual ≥ 100ml, whereas only six women had a relevant postvoid residual postoperatively. In total, the postoperative postvoid residual in all women decreased significantly (p < 0.001). Voiding time decreased significantly postoperatively (p < 0.001) with no significant change in the voided volume (p = 0.352). The maximum flow rate increased postoperatively, reaching no statistically significant change (p = 0.132). Subjective outcome measurements (weak or prolonged stream, incomplete bladder emptying, and straining to void) improved significantly (p < 0.001 for all the questions). Our prospective study demonstrates that sacrocolpopexy to correct pelvic organ prolapse can successfully resolve voiding dysfunction, as both objective and subjective parameters improved significantly after surgery.

Impact of drug use on patient symptom score and quality of life in benign prostatic hyperplasia patients

Introduction: To assess the drug use pattern for treating benign prostatic hyperplasia (BPH) patients and its impact on patient symptom score and quality of life (QoL) of these patients. Materials and Methods: After getting approval from the Indian Council of Medical Research, Institutional Ethics Committee and after obtaining written informed consent from 103 BPH patients, their demographic data, drugs prescribed to them, and scores of International Prostate Symptom Score (IPSS) and Benign Prostatic Hyperplasia Impact Index (BII) were recorded. Patients were reassessed for changes in scores of IPSS, BII, and drug prescription (if any) on the 15th, 30th, and 60th days. Results: 68.93% of patients received drug as a single entity. Patients were classified according to their presenting symptoms as severe, low moderate, and mild with a mean total IPSS score of 16.73% ± 6.6. 37.86% of patients were dissatisfied with QoL and 24.27% of patients had mixed opinion with a mean score of 3.39 ± 1.08. There was a low, medium, moderate, and high total score of BII with a mean BII score of 4.02 ± 2.51. Significant changes were seen in total BII score and frequency of urination on day 15; weak stream, nocturia, total score, and QoL on day 30; and intermittency and urgency on day 60. Incomplete emptying of bladder and straining showed nonsignificant changes. Age and total IPSS score, age and QoL, and age and total BII score showed a negative correlation. Total IPSS score and QoL, total IPSS and BII score, and QoL and total BII score showed a positive correlation. Conclusion: Nonsurgical pharmacological intervention had a positive impact on the IPSS and BII score and health-related QoL in BPH patients.

Correlation between the International Prostate Symptom Score, Ultrasound Features and Maximum Flow Rate in Cameroonian Patients with Benign Prostatic Hypertrophy

Background: Benign prostatic hypertrophy is the non-malignant stromal and epithelial proliferation of the prostate gland, with or without associated anatomical enlargement of the gland and clinical symptoms. Symptomatic Benign prostatic hypertrophy may cause obstructive symptoms, irritative symptoms or both obstructive symptoms include a sensation of incomplete bladder emptying, straining to void, urinary hesitancy and weak stream while irritative symptoms include dysuria, nocturia, urinary frequency and urinary urgency. A quantitative measure of the severity of lower urinary tract symptoms due to benign prostatic hypertrophy can be obtained using the International Prostate Symptoms Score. Ultrasonography is useful for helping to determine bladder and prostate size in patients with urinary lower urinary tract symptoms. Uroflowmetry is a non-invasive test that assesses voiding function. It provides valuable data on the voided volume, time is taken to reach maximum flow rate and average flow rate. The goal of this study was to improve the follow up of patients with benign prostatic hypertrophy by providing simple, available, affordable and non-invasive that best predict bladder outlet obstruction and the quality of life in these patients. Method: This was a cross-sectional analytic study carried out over a period of five months from May 2020 to September 2020 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, which is a tertiary hospital in Cameroon. Were included in the study, adult males who presented with lower urinary tract symptoms and prostatic enlargement suggestive of benign prostatic hypertrophy taking into account clinical, uroflowmetry and ultrasound findings. Results: A study population of 103 participants was recruited. The mean age of patients was 63.17 ± 10.26 years. Concerning the International Prostate Symptoms Score, the mean total, voiding (obstructive) and storage (irritative) scores were 14.6 ± 6.2, 8.5 ± 4.1 and 6.05 ± 2.7 respectively. The mean maximum flow rate was 13.44 ± 3.88 mL/s. The mean prostate volume was 53.71 ± 16.46 ml. A majority of patients have an enlarged prostate 1.5 to 2 times (46 to 60 mL) the upper limit for normal value. The intravesical prostatic protrusion was present in eighty-three (80.58%) and absent in 20 (19.42%). Above a prostate volume of 60 mL, 91% to 100% of our patients had intravesical prostatic protrusion. There was strong evidence (p < 0.001) that a change from no intravesical prostatic protrusion to intravesical prostatic protrusion grade 1 increased the chances of having a low maximum flow rate with a crude odds ratio of 7.98. The adjusted odds ratio after multivariate analysis was 5.26 and this remained statistically significant (p = 0.03). Conclusion: the measure of intravesical prostatic protrusion is superior to the prostate volume in the assessment of maximum flow rate and thus the follow up of patients with benign prostatic hypertrophy. This measure which is non-invasive, easy to measure, easily accessible, and cost effective may be a useful tool in predicting voiding dysfunction and acute urinary retention.

Bilateral Hydrouteronephrosis Dilated Vur with Cystitis: A Case Study

Background: Hydroureteronephrosis is a blockage to free flow of urine from the kidney causes hydroureteronephrosis, which causes dilation of the renal pelvis, calyces, and ureter, resulting in gradual atrophy of the renal cortex. “Dilation of the ureter due to obstruction of urine outflow is called hydroureter”. Hydronephrosis produces a dull pain and discomfort in the lower abdomen due to increasing bladder distension. A continuous obstruction in the flow of urine can lead to high blood pressure, sepsis, urinary tract infection, hematuria, and renal failure.&#x0D; Clinical Findings: Difficulty in passing urine since 2-3month, in situations of benign prostate enlargement, urinary frequency, a weak urine stream, and a sense of incomplete emptying, lack of appetite and fever (Temperature - 101˚F).&#x0D; Diagnostic Assessment: Blood test: Hb – 9.1 gm%, Total RBC count – 5.04millions/cumm, RDW – 17.8%, HCT – 31.9%, Total WBC count – 11600/cumm, Monocytes – 04%, Granulocytes – 30%, Lymphocytes – 64%, AST(SGOT) – 45U/L. Peripheral Smear: RBCs – predominantly microcytic mildly hypochromic with mild anis poikilocytosis showing few pencil cells. Platelets – adequate on smear. No hemiparasite seen.&#x0D; Ultrasonography: The right kidney measure is 5 x1.9cm and left is 5.6 x2.6cm shows mild dilation of pelvic-calyceal system. Left kidney shows mild hydronephrosis with renal pelvic diameter 1.06cm hydroureters seen up to left vesico-urethric junction. Bilateral uterus dilated up to lower end to UVR. Uterus bladder is thickened wall and distended Mild cystitis dilation of B/L dilated uterus and hydronephrosis with UVR.&#x0D; Therapeutic Intervention: Syp Cefixime 2.5ml x BD, Syp. MVBC 5ml x BD, Syp. Calcimax 5ml x BD, Syp. Orofer 5ml x OD, Syp. Nitrofurantoin 2.5ml x BD, Inj. Metro 100mg x TDS, Inj. Pantop 40mg x OD, Inj. Ceftriaxone 500mg IV x B and IVF DNS with Inj. KCL stat.&#x0D; Outcome: After treatment, the child show improvement. No complaint of fever, pain, and difficulty in urine pass and urine frequency .&#x0D; Conclusion: The patient was hospitalized to AVBRH's Pediatric Ward No. 14 with Bilateral hydrouteronephrosis dilated VUR with cystitis. Her health begins to improve when he received proper therapy.

Sensation of incomplete bladder emptying in women: Lack of correlation to an elevated post-void residual.

Sensation of incomplete bladder emptying (SIBE) has been shown to be correlated with an elevated post-void residual (PVR) in men, however, the significance of this symptom and whether it correlates with an elevated PVR in women is less clear. In this study, we assessed if SIBE in women is correlated with an elevated PVR and determined the relationship of SIBE to other lower urinary tract symptoms. Women ages ≥18 with lower urinary tract symptoms were eligible. SIBE was defined by a response "sometimes", "most of the time", or "all of the time" to the question "How often do you feel that your bladder has not emptied properly after you have urinated?" on the International Consultation on Incontinence Questionnaire. Frequency and bother of other lower urinary tract symptoms were also assessed to compare their relationship to SIBE. Elevated PVR was defined as ≥100 ml via ultrasound. We prospectively evaluated 95 women, 59% of whom reported SIBE. Compared to women without SIBE, women with SIBE reported more urinary hesitancy (51% vs. 18%, p = 0.002), intermittency (56% vs. 16%, p < 0.001), weak stream (36% vs. 5%, p < 0.001), dysuria (29% vs. 5%, p = 0.004), and straining (25% vs 5%, p = 0.013). However, there was no difference in elevated PVRs between women with and without SIBE [5/56, 9% vs. 4/39, 10%, (p = 0.99)]. All women, regardless of SIBE, reported higher bother from storage and incontinence symptoms versus voiding symptoms with no difference in overall bother scores. SIBE is a common complaint in women with lower urinary tract symptoms. While women with SIBE reported more voiding symptoms, they were more bothered by storage symptoms. Importantly, most of these women emptied their bladder well and were not more likely to have an elevated PVR than women without SIBE.

Metabolic syndrome and male lower urinary tract symptoms.

Historically, urologists regarded prostate enlargement as the sole cause for male bladder problems. Over time, subdivision of symptoms into storage, voiding and post-voiding symptoms raised awareness of the urinary tract fine-tuning associated with urine storage and voiding, and led to the umbrella term lower urinary tract symptoms (LUTS), which respects bladder and prostate function. While research goes on, it seems as if the more we know about urine storage and voiding, the more complicated it gets: different mechanism can mimic the same symptoms. Clinically, it remains ever the more challenging to understand the pathophysiological context of each patient. Metabolic syndrome (MetS), too, is an umbrella term. Metabolic changes caused by MetS pathophysiologically start with visceral adiposity. It leads to different changes in the signaling pathway including cytokines, elevated transmitters of inflammation, higher levels of free fatty acids (FFA), and adipokines, resulting in vasoconstriction, insulin resistance, impaired glucose uptake and high insulin secretion. Furthermore, MetS is thought to be associated with nephrolithiasis, BPH, LUTS, erectile dysfunction (ED), and infertility. This review aims at synthesizing interactions and consequences of LUTS with MetS. On May 31st, 2021, PubMed and Cochrane were searched with no language nor time restrictions, using the terms "Metabolic syndrome" and "male LUTS." A total of 252 publications were identified. Only papers that mentioned both terms either in their title or in their abstract were included. Hence, 120 papers were reviewed. Many different findings cause LUTS, which are summarized in the EAU Guidelines on male non-neurogenic LUTS. These different symptoms belong to different phases of bladder function. Frequency, nocturia, urgency and incontinence are symptoms of the filling phase, while hesitancy, intermittency, weak or irregular stream, straining and terminal dribble belong to the voiding phase of the bladder. Post-voiding symptoms include post-void dribbling and sensation of incomplete voiding. Symptoms of any phase of bladder function impair quality of life, and are associated with ageing. Inflammation links both umbrella terms, LUTS and MetS. Understanding the exact role of the different elements will not only help to better understand both findings, but also lead to more efficacious treatment, and hopefully, in the future, personalized medicine, by understanding each individual's driving mechanism for LUTS. Reducing inflammation is likely to help patients with MetS and LUTS; further research could therefore focus on how to manage inflammation.

Assessment of Factors Contributing to Delayed Surgeries in Enlarged Prostate Patients: A Survey at Kisumu County Referral Hospital

Enlarged prostate, also known as Benign Prostatic Hyperplasia (BPH) is the enlargement of the prostate gland in men resulting in frequent urination, weak urine stream, and inability to completely empty the bladder. Prostate cancer is the second most commonly occurring cancer in men and the fourth most commonly occurring cancer overall. There were 1.3 million new cases of prostate cancer globally in 2018. Although there is a scarcity of information on the disease in African men, past studies have revealed that the disease can be managed if detected in its early stages. The purpose of the study was to assess the factors contributing to delayed surgeries in enlarged prostate patients at Kisumu County Referral hospital. Specific objectives were to determine the level of knowledge and awareness on enlarged prostate; assess institutional factors hindering surgeries in enlarged prostate and determine socio-economic factors of the patients’ hindering surgeries in enlarged prostate at Kisumu County Referral hospital. A descriptive survey design was adopted for the study. The study targeted enlarged prostate patients and top management of the Kisumu County Referral Hospital from which a sample of 50 respondents was selected using the inclusion-exclusion criteria to participate in the study. The study adopted structured questionnaires for data collection. Data were analysed using descriptive statistics with both qualitative and quantitative analysis and the findings were presented in frequency distribution tables and percentages. The study achieved a questionnaire return rate of 94% with the majority of the respondents, 45%, earning a monthly income ranging from 10,000 to 20,000. Findings revealed that 91%, had knowledge of prostate cancer with 83% stating that the medium through which they learned of the disease was the media, friends, relatives, and at the workplace. Unwillingness to be screened for prostate cancer was due to a lack of knowledge (53%). The study established the hospital was crowded, 78%, and thus the available resources were not sufficient to cater to the population seeking medical attention. Institutional factors related to doctors’/nurses’ workmanship were the common contributors to delayed surgeries and medical attention in terms of negligence, 66%, poor communication channels hence conflicting information, 72%, and doctors’/nurses’ competence at work, 42%. Evidently, the family plays a major role in one’s health decisions especially pertaining to chronic diseases such as cancer, 66%. Lack of finances limits access to quality and timely healthcare with 83% and 87% respectively. Conclusively, the majority of the delays in surgeries in enlarged prostate patients at the hospital were due to the institution’s inability in terms of resources, facilities, and qualified and competent personnel. Socio-economic factors also contributed to delayed surgeries in enlarged prostate patients at Kisumu County Referral Hospital. The study recommends mobilization and sensitization to create awareness and increase the knowledge of prostate cancer, the government should intervene through improving the facilities, resources, and staff as a measure to manage the ever-increasing population seeking medical care at the hospital and to find ways of reducing medical costs, especially for cancer patients, so as to enable victims’ access medical care with ease.

Does the I-PSS Accurately Assess Urinary Function in Prostate Cancer Patients? Evidence From a Study of Nursing Verification of Patient Answers

The International Prostate Symptom Score (I-PSS) is a widely used tool for the evaluation of patient-reported lower urinary tract symptoms (LUTS). Urologists and Radiation Oncologists frequently use the I-PSS to help determine a prostate cancer patient's eligibility for a type of treatment, and to follow up quality-of-life outcomes after treatment. I-PSS is also used to define clinical trial eligibility criteria, and is a common means of comparing patient-reported outcomes between studies. The I-PSS is almost 30 years old and has not been modified in the light of contemporary understandings of patient communication. We sought to assess the degree of patient understanding of I-PSS questions by nursing verification at the time of the patient visit.Men with prostate cancer self-completed an online I-PSS questionnaire approximately one week prior to their visit with the physician. On the day of the visit, a nurse reviewed each I-PSS question with the patient to ensure they understood it, and then verified patient answers. Patient initial scores and nurse-verified scores were recorded, and the results analyzed for discrepancies.I-PSS scores were recorded for 105 men. Complete concordance between patient and nursing scores on all questions was reported for 62 men (59%; 95% C.I. 49%, 69%). The frequency of discordance was highest for urgency (20%), incomplete emptying (22%) and frequency (21%), with lower rates for intermittency (17%), nocturia (15%), weak stream (12%) and straining (7.6%). There was evidence that patients overstated scores compared to nurses for frequency (P = 0.010), weak stream (P = 0.036) and incomplete emptying (P = 0.012); for other domains, there was no evidence for either nurse or patient scores being higher (P≥0.3 for all). For incomplete emptying, nurse scores were lower for 19 men, 15 of whom had a score reduced to zero; for frequency, scores were lower for 14, with 7 reduced to zero.Patient I-PSS scores were moderately concordant with scores obtained after nursing review and verification. Some men appear to have had a poorer understanding of the questionnaire, particularly with respect to items concerning incomplete emptying and frequency. Consideration should be given to rewording the I-PSS to improve patient understanding.

Homoeopathic treatment for lower urinary tract symptoms in men with benign prostatic hyperplasia: an open randomized multicentric placebo controlled clinical trial

Homoeopathic treatment for lower urinary tract symptoms in men with benign prostatic hyperplasia: an open randomized multicentric placebo controlled clinical trial

RETROSPECTIVE MULTICENTRIC STUDY ON THE POST-SURGERY SYMPTOMATIC AND OBJECTIVE IMPROVEMENT OF BENIGN PROSTATIC HYPERPLASIA PATIENTS

Objectives: To evaluate patients of benign prostatic hyperplasia (BPH) preoperatively and identify those who would benefit from surgery, to evaluate outcome of surgery for BPH with respect to symptomatic and objective improvement of patients, and to compare the results of different surgeries for BPH being done different hospitals at Bhopal, which included transurethral resection of the prostate (TURP), transurethral incision of prostate (TUIP)/bladder neck incision (BNI), and Freyer’s prostatectomy? Methods: The present study was carried out at different hospitals of Bhopal. Patients presenting to the surgery outpatient department with symptoms of obstruction, namely, weak urinary stream, frequency hesitancy, intermittency, urgency, nocturia, etc., were included in the study. Some of the subjects included were patients presenting during emergency timings with complaints of retention of urine or occasionally other symptoms. The American Urological Association (AUA) Symptom Index questionnaire was administered to all such patients. They were also evaluated by ultrasound examination and patients having BPH on ultrasound (USG) were further evaluated by uroflowmetry. Results: Prostatic weight correlated well with the maximum urinary flow rates with an inverse relationship. Both maximum and average urinary flow rates (Q max and Qav) were improved by all the three surgeries However, TURP and Freyer’s prostatectomy showed greater improvement as compared to TUIP/BNI. Combination of AUA scoring, USG, and uroflowmetry helped us document improvement in our BPH patients and compared it favorably with other studies. Conclusion: Uroflowmetry was a simple assessment tool easy to learn and use. It was also inexpensive and formed a useful extension to clinical examination providing objective evidence of obstruction. It also helped to indirectly quantity the severity of obstruction. Symptom severity did not correlate with prostate size. Small prostates caused symptoms in the severe range also while even large prostates sometimes caused little symptoms. Prostatic weight correlated well with the maximum urinary flow rates with an inverse relationship.

Digital image manipulation detection with weak feature stream

Digital image manipulation detection with weak feature stream