Conservative Bladder Management and Medical Treatment in Chronic Spinal Cord Injury Patients.

To review the available data on non-surgical management for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI) and provide the most updated knowledge for readers. We categorized the bladder management approaches into storage and voiding dysfunction separately; both are minimally invasive, safe, and efficacious procedures. The main goals for NLUTD management are to achieve urinary continence; improve quality of life; prevent urinary tract infections and, last but not least, preserve upper urinary tract function. Annual renal sonography workups and regular video urodynamics examinations are crucial for early detection and further urological management. Despite the extensive data on NLUTD, there are still relatively few novel publications and there is a lack of high-quality evidence. There is a paucity of new minimally invasive and prolonged efficacy treatments for NLUTD, and a partnership between urologists, nephrologists and physiatrists is required to promote and ensure the health of SCI patients in the future.

A case report of right cardiac ventricle perforation by uncontrolled embolization coil inserted for treating penile veno-occlusive dysfunction.

Coil embolization (CE) is believed effective-safe for treating penile veno-occlusive dysfunction (VOD). From 2012 to 2016, refractory impotence prompted four men to seek further treatment, although they underwent six CEs elsewhere. Uncontrolled coils scattered along penile drainage veins including the deep dorsal veins (n = 3), periprostatic plexus (n = 1), iliac vein (n = 1), right pulmonary artery (n = 2), left pulmonary artery (n = 1), and right ventricle (n = 1). The last one occurred in a 40-year-old house builder, and the coil perforated the right ventricle wall and diaphragm 18 months later. Given no sustainable improvement, CE's safety and efficacy are unreliable for treating patients with VOD.

Preoperative %p2PSA and Prostate Health Index Predict Pathological Outcomes in Patients with Prostate Cancer Undergoing Radical Prostatectomy.

To evaluate the predictive accuracy of the %p2PSA and prostate health index (PHI) in predicting aggressive pathological outcomes in patients with prostate cancer (PCa) undergoing radical prostatectomy (RP), we enrolled 91 patients with organ-confined PCa who were treated with robot-assisted RP. p2PSA levels and the PHI were investigated for their ability to predict pathological results. The %p2PSA and PHI were both significantly higher in patients with ≥pT3 disease, high-risk disease, positive surgical margin, or seminal vesical invasion (SVI). In univariable analysis, p2PSA derivatives were significant predictors of the presence of ≥pT3 disease, high-risk disease, positive surgical margin, and SVI. To predict adverse pathological outcomes at a sensitivity of 90%, p2PSA derivatives had higher specificity than standard PSA derivatives. In multivariable analysis, additional increases in the area under the receiver operating characteristic curve (AUC) were observed with the %p2PSA and PHI for ≥pT3 disease, high-risk disease, and positive surgical margin (8.2% and 2.7%, 6.2% and 4.1%, and 8.6% and 5.4%, respectively). A PHI ≥61.26 enhanced the predictive accuracy of the model for SVI by increasing the AUC from 0.624 to 0.819 (p = 0.009). The preoperative %p2PSA and PHI accurately predict adverse pathological results and are useful for decision-making.

The impact of primary location and age at orchiopexy on testicular atrophy for congenital undescended testis.

In this study, we investigated post-orchiopexy testicular growth of undescended testes (UDTs) at different primary locations and determined the risk factors for testicular atrophy (TA). We conducted a retrospective chart review of boys who had undergone orchiopexy for UDTs during January 2001-December 2013. Patient profile, age at operation, primary UDT location, and testicular volume were noted. TA was defined as ≥50% loss of volume after orchiopexy. The primary endpoints were testicular growth and TA after orchiopexy. The secondary endpoint was risk factors for TA. In total, 182 boys had undergone regular ultrasonography; the median follow-up period was 34 months. Among 230 UDTs, 18 (7.8%) atrophic testicles were identified within a median interval of 13 months after orchiopexy. TA rates were 3.3% (1/30), 6.9% (12/173), and 18.5% (5/27) in primary suprascrotal, canalicular, and above-inguinal UDTs, respectively. The survival probability of UDT was 91%, 92% and 100% when orchiopexy was performed in age ≤1 year, 1 < age ≤2 years, and 100% in age >2 years, respectively. Multivariate analysis revealed that inguinal and above-inguinal UDTs (hazard ratio [HR] 11.76, 95% confidence interval [CI] 1.55-89.33, p = 0.017) and genetic or endocrine disorders (HR 3.19, 95% CI 1.19-8.56, p = 0.021) were the risk factors for TA, but not age at operation, premature birth, and laterality. Thus, TA incidence was higher when patients had high primary testicular locations. Early orchiopexy before two years of age may be associated with higher TA risk, while most testicles have promising growth after orchiopexy.

Trifecta outcome of ureteral reconstruction in iatrogenic injury and non-iatrogenic ureteral lesions: a 10-year experience at a tertiary referral center.

PURPOSE: To analyze the trifecta outcome (functional, anatomical, and surgical aspects) of surgical reconstruction for ureteral lesions and investigate the factors affecting the success rate of such reconstruction. METHODS: We retrospectively reviewed the data of patients who underwent ureteral reconstruction at our institute between March 2007 and November 2016. Patient profiles, surgical methods, complications, ureteral stenting, laboratory data, and image studies were collected. The trifecta outcome was defined as preserved renal function, no progression of hydronephrosis, and no long-term stenting. The primary endpoint was the percentage of patients who achieved the trifecta outcome. The secondary endpoint was risk factors for trifecta outcome failure. RESULTS: We retrospectively reviewed 178 adult patients who had undergone ureteral reconstruction. The median follow-up period was 37.4 months. In total, 70 (39.3%) patients had iatrogenic ureteral injuries and 108 (60.7%) patients had non-iatrogenic ureteral lesions. Overall, 70% of the patients achieved the trifecta outcome after ureteral reconstruction. A multivariate analysis revealed that risk factors for trifecta failure were malignant diseases [odds ratio (OR) 2.93, p = 0.005], a history of pelvic radiation (OR 3.08, p = 0.032), preoperative estimated glomerular filtration rate < 60 (OR 2.52, p = 0.039), and a type of reconstruction ureteroureterostomy (OR 2.99, p = 0.014). CONCLUSIONS: Trifecta outcome could be used to evaluate the ureteral reconstruction in iatrogenic injury and non-iatrogenic ureteral lesions. This study revealed several risk factors that affected the trifecta outcome.

Development of a chitosan-based tissue-engineered renal proximal tubule conduit.

Renal proximal tubule cells (RPTCs) are responsible for glomerular filtration and maintenance of water/electrolyte balance. To regenerate a proximal tubule, sufficient cell numbers and normal cell function are requisite. Collagen has been routinely used as a substrate for culturing human RPTCs (HRPTCs); however, the role of biomaterials has not been thoroughly explored. In this study, RPTCs retrieved from human nephrectomy/nephroureterectomy specimens were cultivated on chitosan as a substrate in serum-free condition for up to 150 days. HRPTCs could maintain a typical epithelial morphology and the specific differentiation feature of transporting epithelia after such long-term culture. As compared with HRPTCs cultivated on collagen, those cultivated on chitosan showed more dome formation, higher Na+ -K+ ATPase expression, lower vimentin expression, and lower transepithelial electrical resistance, indicating that HRPTCs cultivated on chitosan presented better differentiation status and would be more functional with better active transportation. Thus, the current study indicates greater scope for the use of chitosan as a biomaterial for preparing a HRPTC-coated chitosan conduit, which might be useful for the scaffold design of tissue-engineered proximal tubules. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 9-20, 2018.

Chitosan delaying human fibroblast senescence through downregulation of TGF-ß signaling pathway.

This study evaluated the effect of chitosan, poly vinyl alcohol (PVA) and poly (2-hydroxyethyl methacrylate) (pHEMA) on delaying the human fibroblast senescence. Cells could form suspending multicellular spheroids on these biomaterials, but only chitosan was capable of decreasing the SA ß-gal activity and increasing the proliferation ability of senescent fibroblasts. Therefore, in addition to the structure of multicellular spheroids, chitosan itself should play an important role in delaying fibroblast senescence. The main difference of senescence-related protein expressions for cells cultured on chitosan, PVA and pHEMA occurred on the TGF-ß signaling pathway. In addition to the intracellular TGF-ß expression, the extracellular TGF-ß expression was also downregulated. Chitosan with cationic amino structure was assumed to bind with anionic TGF-ß by forming polyelectrolyte complexes. This assumption was demonstrated by directly adding chitosan into the medium to downregulate the cell TGF-ß expression and further to delay cell senescence, indicating TGF-ß signaling pathway was involved in the chitosan-mediating fibroblast senescence process. Finally, the delaying cell senescence ability of chitosan increased with increasing the amount of amino groups in chitosan and its ionization degree. In summary, these results provide important information for considering the application of chitosan in the future cell therapy and regeneration medicine.

Advantage of early orchiopexy for undescended testis: Analysis of testicular growth percentage ratio in patients with unilateral undescended testicle.

This study reports the experience of our tertiary referral center and proposes a new indicator, the growth percentage ratio (GPR), for determining the optimal timing of surgical intervention. A retrospective review of boys who underwent orchiopexy for undescended testis from 2001 to 2013 was conducted. We analyzed testicular volumes in different age groups using the UDT to normally descended testis ratio and testicular GPR. A total of 134 boys with unilateral undescended testicle underwent regular ultrasonography follow-up examinations for more than a mean of 3.9 years. Forty-five (33.4%) of them underwent orchiopexy before the age of one year. Orchiopexy at this age resulted in a GPR (2.02 ± 0.40) that was significantly higher than the GPRs in the second (1 < age ≤ 2 years, 1.25 ± 0.13, p = 0.004) and third (age > 2 years, 1.24 ± 0.14 p = 0.008) age groups. The undescended testicle grew faster when orchiopexy was performed before one year of age. Orchiopexy performed within one year from birth significantly accelerates the growth of the UDT, as determined using the GPR, compared to other age groups. The present clinical evidence indicates that orchiopexy should be performed before one year of age.

Far infrared radiation promotes rabbit renal proximal tubule cell proliferation and functional characteristics, and protects against cisplatin-induced nephrotoxicity.

Far infrared radiation, a subdivision of the electromagnetic spectrum, is beneficial for long-term tissue healing, anti-inflammatory effects, growth promotion, sleep modulation, acceleration of microcirculation, and pain relief. We investigated if far infrared radiation is beneficial for renal proximal tubule cell cultivation and renal tissue engineering. We observed the effects of far infrared radiation on renal proximal tubules cells, including its effects on cell proliferation, gene and protein expression, and viability. We also examined the protective effects of far infrared radiation against cisplatin, a nephrotoxic agent, using the human proximal tubule cell line HK-2. We found that daily exposure to far infrared radiation for 30 min significantly increased rabbit renal proximal tubule cell proliferation in vitro, as assessed by MTT assay. Far infrared radiation was not only beneficial to renal proximal tubule cell proliferation, it also increased the expression of ATPase Na+/K+ subunit alpha 1 and glucose transporter 1, as determined by western blotting. Using quantitative polymerase chain reaction, we found that far infrared radiation enhanced CDK5R1, GNAS, NPPB, and TEK expression. In the proximal tubule cell line HK-2, far infrared radiation protected against cisplatin-mediated nephrotoxicity by reducing apoptosis. Renal proximal tubule cell cultivation with far infrared radiation exposure resulted in better cell proliferation, significantly higher ATPase Na+/K+ subunit alpha 1 and glucose transporter 1 expression, and significantly enhanced expression of CDK5R1, GNAS, NPPB, and TEK. These results suggest that far infrared radiation improves cell proliferation and differentiation. In HK-2 cells, far infrared radiation mediated protective effects against cisplatin-induced nephrotoxicity by reducing apoptosis, as indicated by flow cytometry and caspase-3 assay.

Association between ischaemic bowel syndromes and androgen deprivation therapy in patients with prostate cancer: a retrospective cohort study.

OBJECTIVE: This study investigated the risk of ischaemic bowel syndrome (IBS) in androgen deprivation therapy (ADT) users to explore the long-term outcomes of patients with prostate cancer (PC) receiving ADT treatment. METHODS: We performed a population-based retrospective cohort study. All the clinical information of the study participants were acquired from the Longitudinal Health Insurance Database for Catastrophic Illness Patients in Taiwan. We extracted data for all the patients newly diagnosed with prostate malignancy (ICD-9-CM 185 or C61 in ICD-10-CM) from 2000 to 2008. The patients were then divided into two groups: 7160 male ADT cohort receiving ADT and 7160 male non-ADT comparison group frequency matched by age and index year of ADT treatment of the ADT group. Cox proportional hazard regression was used to estimate the adjusted HR and 95% CIs of the IBS risk. RESULTS: No significant difference was noted in the overall incidence rate for IBS between the ADT and non-ADT cohorts (0.86 and 0.89 per 1000 person-year, respectively, p=0.89). Even after adjusting for potential risk factors, a 1.06-fold risk of IBS (95% CI 0.62 to 1.82, p=0.82) was observed in the ADT cohort relative to the non-ADT cohorts. Moreover, we stratified the ADT cohort by time point of ADT treatment after PC diagnosis. Different IBS incidence rates were observed among the early ADT, late-ADT and non-ADT users at 0.77, 1.23 and 0.89 per 1000 person-years, respectively; nonetheless, the difference was not statistically significant. Moreover, no difference was found between the ADT treatment types and IBS risk, including sole orchiectomy, sole luteinising-hormone-releasing hormone and both. CONCLUSIONS: Results showed that ADT treatment in patients with PC is not an independent factor for IBS incidence. Large sample sizes for patients with IBS with patients with PC who had received ADT treatment are needed for further study.

Lowest Acceptable Bladder Capacity for Interpretation of Uroflowmetry Tests in Children.

OBJECTIVE: To determine the age-specific lowest acceptable value of bladder capacity (LABC) for interpretation of uroflowmetry tests in children. METHODS: From September 2008 through July 2012, healthy children aged 4-9 years were enrolled. All children were asked to have two sets of uroflowmetry and post-void residual (PVR) tests. We selected the tests with lower bladder capacity (voided volume+ PVR) of each child to analyze the LABC. Only bell shaped curves were regarded as normal. PVR >20 mL and Qmax <15 mL/s in children aged 4-6 years, and PVR >10 mL, Qmax <15.0 mL/s in children aged 7-9 years were defined as abnormal, respectively. Receiver operative characteristic curves were used to determine the age-specific cut-off value of LABC. The upper boundary of optimal bladder capacity (OBC) for interpretation of uroflowmetry was defined at 115% expected bladder capacity, and LABC as lower boundary. Linear regression was used to establish the relationship between age and LABC. RESULTS: Totally, 930 children were eligible for analysis of LABC. Through ROC curve analysis and regression analysis, the best fitted age specific LABC defined though differentiating low Qmax is 52.08 mL + age in years × 4.78 mL. For simplicity, the proposed LABC is age in years × 5 + 50. Good reproducibility of normal flow pattern, Qmax and PVR in each child were observed in the uroflowmetry tests within OBC. CONCLUSION: Through the large scale study for uroflowmetry tests in children, we proposed the age-specific lowest acceptable bladder capacity for interpretation of uroflowmetry tests as age in years × 5 + 50 mL.

Rapid differentiation of cocci/mixed bacteria from rods in voided urine culture of women with uncomplicated urinary tract infections.

OBJECTIVES: To evaluate the ability of laser flow cytometry to predict cocci/mixed growth in the pre-analytical phase of urine specimens. METHODS: We retrospectively reviewed urine samples from women with uncomplicated urinary tract infections from urologic clinics for study. Urine analyses were performed with laser flow cytometry (UF1000i, Sysmex, Kobe, Japan) and then diagrams were generated (forward scatter vs. fluorescent light scatter). Each specimen (bacteria count >357 BACT/µL) was classified as either cocci bacteria or rods/mixed growth according to the diagrams. Standard urine cultures were performed, and the agreement between cultures and the UF1000i interpretations was analyzed with kappa statistics. RESULTS: Finally, 491 specimens met the criteria for analysis. Among the 376 specimens with single bacteria growth, there were 26 gram-positive cocci (13 Streptococci spp., 7 Staphylococci spp., 6 Enterococci spp.), 1 gram-positive rods (Corynebacterium spp.), and 349 gram-negative rods (273 Escherichia coli, 33 Klebsiella spp., 29 Proteus spp., 6 Citrobacter spp., 4 Enterobacter spp., 3 Pseudomonas spp., and 1 Providencia spp.). There were 115 specimens with two bacteria species or more that were regarded as mixed growth. Agreement of rods or cocci/mixed growth between the laser flow cytometry and urine cultures yielded a kappa value of 0.58. The positive and negative predictive rate of the UF1000i for cocci/mixed growth in voided urine culture was 81.8% and 84.7%, respectively. CONCLUSIONS: Through laser flow cytometry, we can predict growth of cocci/mixed growth in the pre-analytical phase of urine culture, thus avoiding unnecessary urine culture and waiting time.

Are Middle-Aged Men with Chronic Kidney Disease at Higher Risk of Having Nocturia than Age-Matched Controls.

OBJECTIVE: We compared the lower urinary tract symptoms between middle-aged men with and without chronic kidney disease (CKD) under 50 years of age. METHODS: Between October 2010 and July 2013, patients with CKD aged below 50 who received regular follow-ups at the nephrology outpatient clinics were enrolled. We also enrolled men aged below 50 years with estimated glomerular filtration rates (eGFR) higher than 60 mL/min per 1.73 m(2) and without history of kidney diseases from the health examination department as the control group. Clinical parameters and laboratory parameters were collected for analysis and comparison. The lower urinary tract symptoms were evaluated using the International Prostate Symptom Score (IPSS). Metabolic syndromes were defined according to the ATP III guidelines. RESULTS: Overall, 50 men with CKD and 187 age-matched men without CKD were enrolled in the study (age: 44.9 ± 6.9 vs. 43.7.0 ± 4.3, P = 0.11). When compared with the age-matched control group, the occurrences of lower urinary tract symptoms were fewer in CKD patients, though not statistically significant. CKD Patients had significantly higher scores of nocturia (1.3 vs. 0.8, P = 0.02) but had significantly less urinary frequency and relatively fewer urgency score. Nocturia was significantly associated with eGFR. Multivariate analysis showed that lower eGFR and overweight were the only two independent risk factors for nocturia (P < 0.01), but was not the case for metabolic syndromes. CONCLUSION: Middle-aged men with CKD had significantly more nocturia episodes than the age-matched control group, but had lower urinary frequency scores. Lower eGFR and overweight are independent risk factors for nocturia in middle-aged men.

Chitosan Treatment Delays the Induction of Senescence in Human Foreskin Fibroblast Strains.

Fibroblasts have been extensively used as a model to study cellular senescence. The purpose of this study was to investigate whether the human foreskin fibroblast aging process could be regulated by using the biomaterial chitosan. Fibroblasts cultured on commercial tissue culture polystyrene (TCPS) entered senescence after 55-60 population doublings (PDs), and were accompanied by larger cell shape, higher senescence-associated ß-galactosidase (SA ß-gal) activity, lower proliferation capacity, and upregulation of senescence-associated molecular markers p21, p53, retinoblastoma (pRB), and p16. Before senescence was reached, PD48 cells were collected from TCPS and seeded on chitosan for three days (PD48-Cd3) to form multicellular spheroids. The protein expression of senescence-associated secretory phenotypes (SASPs) and senescence-associated molecular markers of these cells in PD48-Cd3 spheroids were downregulated significantly. Following chitosan treatment, fibroblasts reseeded on TCPS showed lower SA ß-gal activity, increased cellular motility, and a higher proliferation ability of 70-75 PDs. These phenotypic changes were not accompanied by colonies forming in soft agar and a continuous decrease in the senescence-associated proteins p53 and pRB which act as a barrier to tumorigenesis. These results demonstrate that chitosan treatment could delay the induction of senescence which may be useful and safe for future tissue engineering applications.

Reliability and Validity of a Chinese Version of Urinary Tract Infection Symptom Assessment Questionnaire.

OBJECTIVES: Our study evaluates the reliability and validity of a Chinese version of the Urinary Tract Infection Symptom Assessment questionnaire (UTISA). MATERIAL AND METHODS: Our study enrolled women who were diagnosed with uncomplicated urinary tract infection (uUTI) at clinics. The Chinese version of UTISA was completed upon first visit to the clinic for uUTI and at 1-week follow-up. We enrolled 124 age-matched women without uUTI from the community as the control group. The UTISA consists of 14 items (seven symptom items and seven related to quality of life), with each item scoring 0 to 3. The internal consistency was assessed with Chronbach's alpha test. Factor analysis was used to classify symptoms into latent factors. The predictive validity was analyzed by using logistic regression and Receiver Operating Characteristic (ROC) curve analysis. RESULTS: Mean total symptom scores of the UTISA in the 169 cases and 124 controls were 8.9 ± 4.6 and 1.4 ± 2.4, respectively (p < 0.01). The alpha coefficient was 0.77, showing a homogeneous composition of symptoms. At a cut-off value of greater than 3, the UTISA symptom score had good predictive value for uUTI (sensitivity of 87.0%, and specificity of 93.1%). Factor analysis revealed two latent variables: 1) lower urinary tract symptoms and 2) physical symptoms. Among the seven items, we found that urinary frequency (OR = 2.6), dysuria (OR = 5.0), sense of incomplete emptying (OR=2.0), and hematuria (OR=7.6) were significant predictors for uUTI. CONCLUSIONS: The Chinese version of UTISA is reliable to predict uncomplicated UTI in women with an optimal cut-off point at > 3.

Malignant Ureteral Obstruction: Functional Duration of Metallic versus Polymeric Ureteral Stents.

BACKGROUND: Ureteral obstruction caused by extrinsic compression is often associated with intra-abdominal cancers. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. Novel designs of ureteral stents made of different materials have been invented to achieve better drainage. In this study, we described the functional outcomes of a Resonance metallic ureteral stent (Cook Medical, Bloomington, Indiana, USA) in patients with malignant ureteral obstruction and compare the functional duration of Resonance stents with regular polymeric stents in the same cohort. METHODS: Cancer patients who received polymeric stents and subsequent Resonance stents for ureteral obstruction between July 2009 and November 2012 were included in a chart review. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional durations of each stent were calculated, and possible factors affecting stent patency were investigated. RESULTS: A total of 50 stents were successfully inserted into 50 ureteral units in 42 patients with malignant ureteral obstruction. There were 7 antegrade stents and 43 retrograde stents. There were no major complications. Stent-related symptoms were similar in both kinds of stents. After polymeric stents were replaced with Resonance metallic stents, hydronephrosis subsided or remained stable in 90% (45/50) of the ureteral units. Serum creatinine decreased or remained stable in 90% (38/42) of these patients. The Resonance stent exhibited a mean increase in functional duration of 4 months compared with the polymeric stents (p<0.0001), and 50% (25/50) of the Resonance stents exhibited a significant increase in functional duration (more than 3 months). Pre-operative serum creatinine < 2 was associated with a substantial increase in stent duration. CONCLUSIONS: Resonance stents are effective and safe in relieving malignant ureteral obstructions after polymeric stents failure. Resonance stents can provide a longer functional duration than polymeric stents and should be offered as an option for internal drainage.

Reliability and Validity of a Chinese Version of Urinary Tract Infection Symptom Assessment Questionnaire

ABSTRACTObjectives:Our study evaluates the reliability and validity of a Chinese version of the Urinary Tract Infection Symptom Assessment questionnaire (UTISA).Material and Methods:Our study enrolled women who were diagnosed with uncomplicated urinary tract infection (uUTI) at clinics. The Chinese version of UTISA was completed upon first visit to the clinic for uUTI and at 1-week follow-up. We enrolled 124 age-matched women without uUTI from the community as the control group. The UTISA consists of 14 items (seven symptom items and seven related to quality of life), with each item scoring 0 to 3. The internal consistency was assessed with Chronbach's alpha test. Factor analysis was used to classify symptoms into latent factors. The predictive validity was analyzed by using logistic regression and Receiver Operating Characteristic (ROC) curve analysis.Results:Mean total symptom scores of the UTISA in the 169 cases and 124 controls were 8.9±4.6 and 1.4±2.4, respectively (p<0.01). The alpha coefficient was 0.77, showing a homogeneous composition of symptoms. At a cut-off value of greater than 3, the UTISA symptom score had good predictive value for uUTI (sensitivity of 87.0%, and specificity of 93.1%). Factor analysis revealed two latent variables: 1) lower urinary tract symptoms and 2) physical symptoms. Among the seven items, we found that urinary frequency (OR=2.6), dysuria (OR=5.0), sense of incomplete emptying (OR=2.0), and hematuria (OR=7.6) were significant predictors for uUTI.Conclusions:The Chinese version of UTISA is reliable to predict uncomplicated UTI in women with an optimal cut-off point at >3.

Temporal trend of newly diagnosed incidence, medical utilization, and costs for pediatric urolithiasis, 1998-2007: a nationwide population-based study in Taiwan.

OBJECTIVE: To investigate the trends of newly diagnosed incidence, medical utilization, and medical costs for pediatric urolithiasis in Taiwan. MATERIALS AND METHODS: The present study uses the National Health Insurance Research Database, which contains the data of all medical benefit claims from the individuals enrolled in the national and single-payer insurance program in Taiwan. The National Health Insurance covered 22,717,053 enrollees, nearly 99% of Taiwan's population. Our analysis includes all subjects aged <18 years with a primary diagnosis of urolithiasis. We analyzed the temporal trend for annual newly diagnosed incidence, medical care visits, and medical costs for pediatric urolithiasis from 1998 to 2007. RESULTS: A total of 1474 patients aged <18 years with newly diagnosed urolithiasis were identified, including 719 (48.8%) boys and 755 (51.2%) girls. The overall newly diagnosed rate of urolithiasis in pediatric population was 0.038% in 2007. The peak age stratum of urolithiasis occurrence in 2007 was 15-18 years. The trend of annual newly diagnosed incidences for boys, girls, and all children declined from 1998 to 2007. Furthermore, there were declining trends both in medical costs and annual medical care visits during the study period. CONCLUSION: This is the first nationwide population-based study to indicate the declining trends in newly diagnosed rate, medical care visits, and medical costs for pediatric urolithiasis. These findings help to quantify and establish the burden of pediatric urolithiasis. These findings help to quantify and establish the burden of medical care for pediatric urolithiasis and to further refine the medical policy.

Obese children at higher risk for having overactive bladder symptoms: a community-based study.

AIMS: To investigate the association between obesity and lower urinary tract symptoms (LUTS) in healthy children. METHODS: Healthy community children (5-12 years) were enrolled to evaluate LUTS and voiding function, and classified by body mass index as being of normal weight, overweight, or obese. A questionnaire was completed by one parent of each child and included baseline characteristics, Dysfunctional Voiding Symptom Score, obstructive sleep apnea-related symptoms, stressful events, and nocturnal enuresis status in the past months. Overactive bladder (OAB) was defined by an urgency symptom score of ≥ 2. Monosymptomatic nocturnal enuresis (MNE) was defined as nocturnal enuresis without either OAB or daytime incontinence. RESULTS: A total of 838 children (mean age, 8.0 ± 2.0 years) were eligible for analysis. The prevalence of overweight and obesity was 14.0% and 10.7%, respectively, without gender disparity. Obese children had higher urgency symptom score than children of normal weight (0.87 ± 1.00 vs. 0.60 ± 0.87; P = 0.03). Multivariate analysis showed that significant risk factors for OAB were younger age (OR, 1.17; 95% CI, 1.06-1.29) and obesity (OR, 1.97; 95% CI, 1.14-3.40), while not gender, overweight, obstructive sleep apnea-related symptoms, and stressful events. Statistically significant risk factors for MNE were younger age and stressful events, while not obesity. CONCLUSIONS: Obese community children were at a higher risk of having OAB while not for MNE.

The Tzu Chi nomograms for maximum urinary flow rate (Qmax ) in children: comparison with Miskolc nomogram.

OBJECTIVE: To report the first ranking method-based age- and gender-specific nomograms for maximum urinary flow rate (Qmax ) in children. PATIENTS AND METHODS: Healthy children aged 4-12 years were enrolled for two sets of uroflowmetry tests. The first and the higher value of the two consecutive Qmax of each child with a voided volume (VV) of ≥50 mL were included for establishing single- and dual-Qmax nomograms. Children with possible urinary tract infection or lower urinary tract dysfunctions were excluded. RESULTS: In all, 1128 children (583 boys and 545 girls) with a mean (sd) age of 7.7 (2.2) years were eligible for analysis and construction of nomograms. Multivariate analysis showed that the Qmax was significantly affected by age, VV and gender (all P < 0.01). The values of the corresponding percentile of the Qmax were significantly higher in the dual-Qmax nomogram compared with the single-nomogram. In boys aged 8-12 years, the 5th percentile line of the Miskolc nomogram was significantly lower than that of the present nomograms at all VVs. Minimally acceptable Qmax values, around the 10th percentile of the dual-Qmax nomogram, were >11.5 mL/s in children aged ≤6 years and >15.0 mL/s in children aged ≥7 years. External validation is required for the present dual-Qmax nomograms. CONCLUSION: We recommend repeating uroflowmetry in cases with a Qmax lower than the minimally acceptable age- and gender-specific Qmax values.