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Prenatal intervention for urinary obstruction and myelomeningocele
Swana, Hubert S.;Sutherland, Ronald S.;Baskin, Laurence;
International braz j urol , 2004, DOI: 10.1590/S1677-55382004000100010
Abstract: widespread use of ultrasonography has resulted in an increase in the recognition of fetal hydronephrosis. the enthusiasm that accompanied early interventions has been tempered by the experience and results obtained over the past 2 decades. the goal has remained the same: to identify patients with serious prenatal obstruction and to identify those which may benefit from intervention. myelomeningocele remains a devastating congenital anomaly. fetal and experimental studies suggested that patients with myelomeningocele could benefit from prenatal intervention. advances in technology and perinatal management have made intervention for more complex malformations such as myelomeningocele possible. this article will review current knowledge and will detail rational management for the management of prenatal hydronephrosis. the current state of antenatal myelomeningocele repair and the urologic implications will be described as well.
Prenatal intervention for urinary obstruction and myelomeningocele  [cached]
Swana Hubert S.,Sutherland Ronald S.,Baskin Laurence
International braz j urol , 2004,
Abstract: Widespread use of ultrasonography has resulted in an increase in the recognition of fetal hydronephrosis. The enthusiasm that accompanied early interventions has been tempered by the experience and results obtained over the past 2 decades. The goal has remained the same: to identify patients with serious prenatal obstruction and to identify those which may benefit from intervention. Myelomeningocele remains a devastating congenital anomaly. Fetal and experimental studies suggested that patients with myelomeningocele could benefit from prenatal intervention. Advances in technology and perinatal management have made intervention for more complex malformations such as myelomeningocele possible. This article will review current knowledge and will detail rational management for the management of prenatal hydronephrosis. The current state of antenatal myelomeningocele repair and the urologic implications will be described as well.
The management of upper urinary tract obstruction in resource-poort settings
V M Ramyil, N K Dakum, E I Ogwuche
African Journal of Urology , 2007,
Abstract: Objective: The management of upper urinary tract obstruction in the absence of modern facilities presents a major challenge to Urologic practice in developing countries. The aim of this study was to describe the etiology, presentation and treatment of upper urinary tract obstruction at the Jos University Teaching Hospital, Nigeria. Patients and Methods: This is a prospective analysis of 37 consecutive patients (18 males, 19 females) with a mean age of 35.5 years (range 3-55) who were managed for upper urinary tract obstruction at our department between January 2001 and December 2005. Two of them presented with a second pathology, so that we treated 39 pathologies in total. Flank pain was the most common clinical feature, being present in 35 patients (94.6%). Other clinical features were gross hematuria in 12 (32.4%), an enlarged kidney in 5 (13.5%), renal impairment in 4 (10.8%) and hypertension in 3 (8.1%) patients. Diagnostic work-up consisted of plain radiography, abdominal ultrasound scan, intravenous urography and retrograde pyelography. Renal pelvic stones were the leading cause of obstruction (13 patients; 35.1%), while congenital pelvi-ureteric junction (PUJ) obstruction was found in 7 (18.9%) and ureteric stricture and vesical schistosomiasis in 4 (10.8%) and 3 (8.1%) patients, respectively. Two patients had bilateral obstruction from two different causes. Results: Twenty-nine open surgical procedures were carried out. They consisted of pyelolithotomy (n=12), pyeloplasty (n=6), ureteroureterostomy (n=4), ureteroneocystostomy (n=3), nephrectomy (n=2) and ureterolithotomy (n=2). Eight patients were treated non-surgically. Two patients are awaiting definitive surgical treatment. A total of 4 (13.8%) complications following 29 operative procedures was encountered: two cases of migration of double-J ureteric stents and one case each of prolonged urine leakage and wound infection. Conclusion: Upper urinary tract obstruction is not uncommon in our environment. In the absence of modern facilities, open surgery remains our main option of treatment; and it is relatively safe. Objectif: La prise en charge de l'obstruction du haut appareil urinaire en l'absence des équipements modernes présente un défi important de la pratique urologique dans les pays en voie de développement. Le but de cette étude était de décrire l'étiologie, la présentation clinique et le traitement de l'obstruction du haut appareil urinaire à l'h pital universitaire de Jos, Nigéria. Patients et méthodes: C'est une analyse prospective de 37 patients consécutifs (18 males, 19 femelles) présentant un age moyen de 35.5 ans (3-55 ans) qui ont été contr lés pour obstruction du haut appareil urinaire à notre service entre janvier 2001 et décembre 2005. Deux ont présenté une deuxième obstruction après qu'ils aient été traités pour la première, de sorte qu'en fait nous avons traité 39 cas. La douleur du flanc était la présentation clinique la plus commune, étant présente chez 35 patients
Role of Urinary Biomarkers in the Diagnosis of Congenital Upper Urinary Tract Obstruction
A A Shokeir
African Journal of Urology , 2007,
Abstract: Objective: Congenital obstructive uropathy constitutes a significant cause of morbidity in children. Currently, there is no reference standard for the diagnosis of renal obstruction in children. The non-invasive measurement of biomarkers in voided urine has considerable appeal as a potential application in children with congenital obstructive nephropathy. The aim of the present review is to explore the current role of biomarkers in the diagnosis and follow-up of obstructive uropathy in children. Patients and Methods: The literature database (PubMed) was searched from inception to May 2007, regarding the role of urinary biomarkers in the diagnosis and follow-up of children with congenital obstructive uropathy. Results: The review included 23 experimental and 33 prospective controlled clinical studies. Several cytokines, peptides, enzymes and microproteins were identified as major contributors to, or as biomarkers ensuing from obstruction-induced renal fibrosis and apoptosis. The most important biomarkers were transforming growth factor-β1 (TGF-β1), epidermal growth factor (EGF), endothelin-1 (ET-1), urinary tubular enzymes [N-acetyl-β-D-glucosaminidase (NAG), γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP)], and microproteins [β2- microglobulin (β2M), microalbumin (M.Alb) and micrototal protein (M.TP)]. All biomarkers showed different degrees of success but the most promising markers were TGF-β1, ET-1 and a panel of tubular enzymes. These biomarkers showed a sensitivity of 74.3% to 100%, a specificity of 80% to 90% and an overall accuracy of 81.5% to 94% in the diagnosis of congenital obstructive uropathy in children. Moreover, some of the markers were valuable in differentiation between dilated non-obstructed kidneys qualifying for conservative management and obstructed kidneys requiring surgical correction. Some studies demonstrated that urinary biomarkers are helpful in evaluating the success of treatment in children with congenital renal obstruction. Some limitations of the previous studies include lack of controls and small sample size. Larger controlled studies are necessary to confirm the clinical usefulness of biomarkers in the diagnosis and follow-up of children with congenital obstructive uropathy. Conclusion: Urinary biomarkers are a promising tool that could be used as a non-invasive assessment of congenital renal obstruction in children.
Bacterial Urinary Tract Infections among Males with Lower Urinary Tract Obstruction at Komfo Anokye Teaching Hos-pital, Kumasi, Ghana  [PDF]
Christian Kofi Gyasi-Sarpong, Edwin Mwintiereh Ta-ang Yenli, Ali Idriss, Addae Appiah Arhin, Ken Aboah, Roland Azorliade, Yaw Agyekum Boaitey, Augustina Angelina Annan
Open Journal of Urology (OJU) , 2012, DOI: 10.4236/oju.2012.23023
Abstract: Purpose: We describe the commonest pathology responsible for lower urinary tract obstruction (LUTO) and associated symptoms such as UTI, etc. among males at the Komfo Anokye Teaching Hospital (KATH) in Kumasi. Materials and Methods: Between January and December 2009, prospective cross sectional hospital based study was conducted involving 103 subjects. Patients with symptoms of LUTO and who were on short admission (up to 48 hours) at the accident and emergency unit of KATH were identified as potential study subjects. All the patients presented with acute retention of urine at the emergency unit of KATH and urethral catheterization was attempted to relieve them of the retention under sterile conditions. Those patients whose initial catheterization failed went through suprapubic cystostomy (suprapubic catheterization). Urine specimens for culture and sensitivity tests were then collected into sterile urine containers immediately after the catheterization (irrespective of type). Ultrasound Scan was requested for all the patients to assist in diagnosing enlargement of the prostate and other associated urological pathologies. Retrograde urethrogram was however, requested for those patients with suprapubic catheterization and which helped in the diagnosis of the urethral stricture. For a particular child, urethral catheter was passed under sterile condition and Micturicting Cysto-Urethrogram (MCUG) was done to assist in diagnosing posterior urethral valve and other conditions. Those subjects whose urinalysis revealed pyuria and positive urine culture and who had voluntarily agreed to enter the study were enrolled. Subjects whose urine culture had multiple bacteria growth that was deemed to be contaminants were excluded from the study. Results: The mean age for males with LUTO was 62 years. The youngest male with LUTO was aged 2 years whilst the maximum age was 93 years. LUTO due to prostatic hyperplasia was found in 79 (76.7%) men; 23 (22.3%) had LUTO due to urethral stricture and 1 (1.0%) (youngest male). The mean age of patients that had LUTO due to urethral stricture was approximately 39 years. The youngest patient with LUTO due to urethral stricture aged 22 years whilst the maximum age was 72 years. Microbiological results indicated that Escherichia coli caused 53 (51.5%) of urinary tract infection (UTI) due to LUTO; Klebsiella = 23 (22.3%); Staphylococcus aureus = 14 (14.6%); Pseudomonas spp. = 8 (7.8%) Proteus = 2 (2.0%); Citrobacter = 1 (1.0%) and Salmonella spp. =1 (1.0%). Conclusion: The most common
A Novel Intraurethral Device Diagnostic Index to Classify Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms  [PDF]
Leonardo O. Reis,Guilherme C. Barreiro,Alessandro Prudente,Cleide M. Silva,José W. M. Bassani,Carlos A. L. D'Ancona
Advances in Urology , 2009, DOI: 10.1155/2009/406012
Abstract: Objectives. Using a urethral device at the fossa navicularis, bladder pressure during voiding can be estimated by a minimal invasive technique. This study purposes a new diagnostic index for patients with lower urinary tract symptoms (LUTSs). Methods. Fifty one patients presenting with LUTSs were submitted to a conventional urodynamic and a minimal invasive study. The results obtained through the urethral device and invasive classic urodynamics were compared. The existing bladder outlet obstruction index (BOOI) equation that classifies men with LUTSs was modified to allow minimal invasive measurement of isovolumetric bladder pressure in place of detrusor pressure at maximum urine flow. Accuracy of the new equation for classifying obstruction was then tested in this group of men. Results. The modified equation identified men with obstruction with a positive predictive value of 68% and a negative predictive value of 70%, with an overall accuracy of 70%. Conclusions. The proposed equation can accurately classify over 70% of men without resorting to invasive pressure flow studies. We must now evaluate the usefulness of this classification for the surgical treatment of men with LUTSs. 1. Introduction Invasive pressure flow studies (PFSs) in urodynamics are still the gold standard method for objective classification of bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTSs). It is able to delineate patients for successful surgical approach [1], however, it is still costly, time-consuming, and associated with significant morbidity. The risks of complications after conventional urodynamic study in men with BOO are greater, and acute urinary retention, macroscopic hematuria, urinary tract infection, and/or fever can occur in over 19% of the cases [2]. During the past 14 years, many experts have raised minimal invasive possibilities as substitutes [3, 4]. Griffiths et al. have previously described and validated a minimal invasive technique based on controlled inflation of a penile cuff during voiding [5]. Others had attempted other types of penile cuffs and condoms with insufficient results [3, 6–9]. Trying to overcome these limitations, we developed, in association with the University’s Biomedical Engineering Department, a urethral device capable of extracting from the voiding patient measurements comparable to those achieved from invasive PFS [10]. We have published before that applying logistic regression fitting to the minimal invasive method utilizing this urethral device was able to detect most patients with BOO [10]. However, the
Monosodium Glutamate (MSG) Consumption Is Associated with Urolithiasis and Urinary Tract Obstruction in Rats  [PDF]
Amod Sharma, Vitoon Prasongwattana, Ubon Cha’on, Carlo Selmi, Wiphawi Hipkaeo, Piyanard Boonnate, Supattra Pethlert, Tanin Titipungul, Piyapharom Intarawichian, Sakda Waraasawapati, Anucha Puapiroj, Visith Sitprija, Sirirat Reungjui
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0075546
Abstract: Background The peritoneal injection of monosodium glutamate (MSG) can induce kidney injury in adult rats but the effects of long-term oral intake have not been determined. Methods We investigated the kidney histology and function in adult male Wistar rats that were fed?ad libitum?with a standard rat chow pellet and water with or without the addition of 2 mg/g body weight MSG/day in drinking water (n=10 per group). Both MSG-treated and control animals were sacrificed after 9 months when renal function parameters, blood and urine electrolytes, and tissue histopathology were determined. Results MSG-treated rats were more prone to kidney stone formation, as represented by the alkaline urine and significantly higher activity product of calcium phosphate. Accordingly, 3/10 MSG-treated rats developed kidney stones over 9 months versus none of the control animals. Further, 2/10 MSG-treated rats but none (0/10) of the controls manifested hydronephrosis. MSG-treated rats had significantly higher levels of serum creatinine and potassium including urine output volume, urinary excretion sodium and citrate compared to controls. In contrast, MSG-treated rats had significantly lower ammonium and magnesium urinary excretion. Conclusion Oral MSG consumption appears to cause alkaline urine and may increase the risks of kidney stones with hydronephrosis in rats. Similar effects in humans must be verified by dedicated studies.
Improvement of renal function after relief of chronic partial upper urinary tract obstruction  [cached]
HA Davari,M Haghighi,Z Shahi,M Hasanzad Azar
Journal of Research in Medical Sciences , 2005,
Abstract: Background: Kidney's functional and anatomical changes reversibility of after treatment of partial ureteropelvic junction obstruction (UPJO) is not defined well. Therefore, in this clinical trial study, we've evaluated these changes. Methods: In a clinical trial study with non randomized-simple sampling, 32 patients with chronic partial obstruction of urinary tract due to unilateral UPJO were studied. In each patient, IVU, DMSA, DTPA, and bilateral kidney sonography were down pre and post operatively. Paired t-test, Wilcoxon, and McNemar tests analyzed data. P-value less than 0.05 was considered significant. Results: Mean age of the patients was 5.44 ± 0.47 years old and 40.6 % of the patients were male. Split function mean in DMSA had significant difference, comparing pre and post operatively (P<0.05). There also was a significant difference in mean of retention time and T1/2 of DTPA (P<0.05), comparing pre and post operatively (P<0.05). Mean of kidney pelvis diameter had significant difference, comparing pre and post operatively (P<0.05). Conclusion: Our study showed that operation of chronic partial obstruction of kidney, could improve kidney function. We also showed that sonographic evaluation of kidneys could help to evaluate kidney function in these patients. Keywords: obstructive uropathy, kidney reversibility, ureter obstruction
Evaluation of the Cost Effectiveness of Vesico-Amniotic Shunting in the Management of Congenital Lower Urinary Tract Obstruction (Based on Data from the PLUTO Trial)  [PDF]
Lavanya Diwakar, Rachel K. Morris, Pelham Barton, Lee J. Middleton, Mark D. Kilby, Tracy E. Roberts
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082564
Abstract: Objective To determine the cost-effectiveness of in-utero percutaneous Vesico Amniotic Shunt (VAS) in the management of fetal lower urinary tract obstruction (LUTO) Design Model based economic analysis using data from the randomised controlled arm of the PLUTO (percutaneous vesico-amniotic shunting for lower urinary tract obstruction) trial. Setting Fetal medicine departments in United Kingdom, Ireland and Netherlands. Population or Sample Pregnant women with a male, singleton fetus with LUTO. Methods Costs and outcomes were prospectively collected in the trial; three separate base case analyses were performed using the intention to treat (ITT), per protocol and uniform prior methods. Deterministic and probabilistic sensitivity analyses were performed to explore data uncertainty. Main Outcome Measures Survival at 28 days, 1 year and disease free survival at 1 year. Results VAS was more expensive but appeared to result in higher rates of survival compared with conservative management in patients with LUTO. Using ITT analysis the incremental cost effectiveness ratios based on outcomes of survival at 28 days, 1 year, or 1 morbidity-free year on the VAS arm were £15,506, £15,545, and £43,932, respectively. Conclusions VAS is a more expensive option compared to the conservative approach in the management of individuals with LUTO. Data from the RCT suggest that VAS improves neonatal survival but does not result in significant improvements in morbidity. Our analysis concludes that VAS is not likely to be cost effective in the management of these patients given the NICE (National Institute of Health and Clinical Excellence) cost threshold of £20,000 per QALY.
The Add-On Effect of Solifenacin for Patients with Remaining Overactive Bladder after Treatment with Tamsulosin for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Obstruction  [PDF]
Naoya Masumori,Taiji Tsukamoto,Masahiro Yanase,Hiroki Horita,Masaharu Aoki
Advances in Urology , 2010, DOI: 10.1155/2010/205251
Abstract: Objectives. To investigate the add-on effect of solifenacin for Japanese men with remaining overactive bladder (OAB) symptoms after tamsulosin monotherapy for lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) in real-life clinical practice. Methods. Patients aged ≥ 50 having remaining OAB symptoms (≥ 3 of OAB symptom score (OABSS) with ≥2 of urgency score) after at least 4 weeks treatment by 0.2?mg of tamsulosin for BPO/LUTS received 2.5 or 5.0?mg of solifenacin for 12 weeks. The International Prostate Symptom Score (IPSS), QOL index and OABSS, maximum flow rate (Qmax) and postvoid residual urine volume (PVR) were determined. Results. A total of 48 patients (mean age 72.5 years) completed the study. There were significant improvement in IPSS (15.1 to 11.2) and QOL index (4.2 to 3.0) by add-on of solifenacin. Although the IPSS storage symptom score was significantly improved, there were no changes observed in the IPSS voiding symptom score. The OABSS showed significant improvement (8.0 to 4.8). No changes were observed in Qmax and PVR. Conclusions. Under the supervision of an experienced urologist, the additional administration of solifenacin to patients with BPO/LUTS treated with tamsulosin, is effective in controlling remaining OAB symptoms. 1. Introduction Overactive bladder (OAB) symptoms are commonly observed in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) [1]. Since 1-blocker monotherapy is efficacious in improving voiding symptoms and to a certain extent OAB symptoms [2, 3], it is recommended as the first line treatment for men with BPO? ?OAB [4]. However, remaining OAB symptoms are sometimes experienced, and such symptoms continuously impair quality of life (QOL). To control OAB symptoms in men with BPO/LUTS, there are four strategies for medical treatment: administration of anticholinergic agent as the first line treatment [5], replace 1-blocker with anticholinergic agent [6], the combination of 1-blocker and anticholinergic agent as the first line treatment [7–10], and additional administration of anticholinergic agent [1, 11, 12]. According to the treatment recommendations proposed by the 6th International Consultation on New Developments in Prostate Cancer and Prostate Diseases [13], 1-blocker and anticholinergic combination therapy is recommended as a first line treatment for men with coexisting bladder outlet obstruction (BOO)? ?OAB symptoms. However, when we consider the promising efficacy of 1-blockers on OAB symptoms in men with BPO and adverse events as
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