Factors associated with low-compliance bladder in end-stage renal disease patients and development of a clinical prediction model for urodynamic evaluation: the DUDi score.

OBJECTIVES: To investigate factors associated with low-compliance bladders (LCB) in pretransplant patients with end-stage renal disease (ESRD) and develop a clinical prediction model for urodynamic studies. METHODS: This study was a prospective cohort study. Patients with ESRD on the renal transplantation waiting list were recruited and underwent the urodynamic study. Demographics data, predictor factors related to the bladder compliance such as underlying disease of the lower urinary tract disease (LUTD), duration of urine < 250 mL/day, type and duration of renal replacement therapy (RRT), urine volume per day and urodynamic study information were collected. Univariable and multivariable logistic regression models were used to assess the independence of explanatory factors, then we developed the clinical prediction model. RESULTS: One hundred fifty-two patients participated in the study: 94 patients in the normal bladder group and 58 patients in LCB group. Demographic data were not significantly different between the two groups, except diabetes. Cystometric capacity, detrusor pressure, compliance were significantly different. From the univariate analysis, DM status, duration of RRT, and passing < 100 mL of urine per day were related to LCB. We named the prediction model, the DUDi score based on the predictors (Duration of RRT, Urine volume/day, Diabetes). Higher scores predicted a higher risk of low-compliance bladder [P value = 0.464 according to the Hosmer-Lemeshow test, and the AUC was 0.87 (95% CI 0.81-0.92)]. CONCLUSIONS: Our clinical prediction model is easy to use and provides a high predictive value that is appropriate for patients who have no known LUTD to identify low-compliance bladder. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION FOR PROSPECTIVELY REGISTERED TRIALS: This study was approved by the Thai Clinical Trials Registry Committee on 09 February 2021. The TCTR identification number is TCTR20210209006.

Challenges management in penile calciphylaxis.

Calciphylaxis is a rare, life-threatening vascular disease, which predominantly affects patients with chronic renal failure treated by dialysis. Penile calciphylaxis is an extremely rare condition, a severe manifestation of calciphylaxis, which is associated with poor prognosis and high mortality rate. Diagnosis and management are challenging and still debatable. We present a case with penile calciphylaxis on whom an arterial bypass to the deep dorsal penile vein was performed. Although, in this case, the method was not permanently successful, the histology showed a cluster of neovascularization after the operation. Deep dorsal arterialization might be a proper technique in well-selected patients.

The safety cutoff storage pressure for preventing upper urinary tract damage in neurogenic bladder from spinal cord pathology and risk factor analysis.

INTRODUCTION: Low-compliance bladder or high bladder pressure undoubtedly leads to hydronephrosis and renal impairment. As four decades have elapsed since a previous study found a detrusor leak-point pressure (DLPP) >40 cm H2 O to result in hydronephrosis, we suspected the possibility of hydronephrosis or vesicoureteral reflux occurring at any point below the 40 cm H2 O DLPP reference. Therefore, this study aimed to determine the storage detrusor pressure value and risk factors related to upper urinary tract damage (UUTD). MATERIALS AND METHODS: This study retrospectively reviewed the hospital records of 110 patients who visited the Neurogenic Bladder TU Service of Excellence Unit, Thammasat University Hospital, Pathum Thani, Thailand, and were diagnosed with neurogenic bladder between 2016 and 2020. The inclusion criteria were as follows: patients who were diagnosed with neurogenic bladder from spinal cord problems (spinal dysraphism, spinal cord disease [tumor, degenerative, arteriovenous malformation, etc.], or traumatic spinal cord injury) and underwent a complete examination, including urodynamic study and renal ultrasound. The exclusion criteria were as follows: patients who had previous pelvic irradiation, other concomitant neurological disease (stroke, Parkinson's disease, etc.), or other urological diseases (stone, tumor, etc.), and those who had an indwelling suprapubic or urethral catheter. We identified the cutoff point for storage pressure related to UUTD using receiver operating characteristic (ROC) curve analysis to identify the value that produced maximum sensitivity and specificity. To identify risk factors for developing UUTD, we included seven risk factors: intravesical pressure, poor compliance, detrusor overactivity (DO), detrusor sphincter dyssynergia (DSD), level of the spinal cord pathology, male sex, and spontaneous voiding in univariable and multivariable regression analyses. RESULTS: Of the 110 patients who met the inclusion criteria, 22 were excluded from the study. Fifty-nine patients had a normal upper urinary tract, and 29 had UUTD. The mean age, sex, voiding pattern, type of spinal cord pathology, and level of spinal cord lesions were not different between the two groups. After performing ROC curve analysis, a cutoff value for daily storage pressure ≥15 cm H2 O provided 79.31% sensitivity and 67.80% specificity (area under the ROC curve: 0.73) for UUTD development. From univariable analysis, low compliance (cutoff values at <12.5 and <20 ml/cm H2 O) and a storage pressure ≥15 cm H2 O was related to UUTD with statistical significance (risk ratio [RR]: 3.16, 2.3, and 3.6, respectively [p < 0.05]). After performing multivariable analysis, a storage pressure ≥15 cm H2 O and both cutoff values for low compliance were related to UUTD with statistical significance (RR: 3.9, 2.4, and 3.2, respectively [p < 0.05]). However, other factors, including male sex, spontaneous voiding, suprasacral lesion, DSD, and DO, were not related to UUTD. CONCLUSION: Our results demonstrated that low compliance and a storage pressure ≥15 cm H2 O were significantly associated with UUTD. Various bladder-management strategies have been developed to prevent UUTDs. However, the main concept continues to be the maintenance of a low storage pressure.

A novel transurethral approach to inlay oral mucosal graft urethroplasty technique for meatal and fossa navicularis stricture resulting from distal hypospadias repair.

INTRODUCTION: Meatal and fossa navicularis stricture after hypospadias repair is a challenging condition. A range of management techniques have been applied to treat meatal and fossa navicularis stenosis but, as yet, there is no consensus as to the best method. Open urethroplasty with oral mucosal graft (OMG) has been widely accepted to be the gold standard in repairing the stricture. Generally, the stricture site is approached through a ventral midline, subcoronal, and circumcising incision. A novel effective technique for short segment stricture, transurethral approach to inlay oral mucosal graft urethroplasty would help in avoiding ventral glans, distal penis or ventral urethral incision and can preserve glans of the penis. METHOD: A 5-year-old boy with mid-shaft hypospadias underwent repair when he was 3 years old. Two months after surgery, he had developed urethral meatal and fossa navicularis stenoses. He is to undergo a novel transurethral approach of inlay OMG urethroplasty. The procedure consisted of transurethral excising the fibrotic tissue at the dorsal site of the stricture urethra. The bougies dilator was used for calibrating the size of the urethra up to 12 Fr. An OMG with a size of 5 × 6 mm was then harvested from the lower lip and applied to cover the defect. A urethral catheter was inserted for 1 week. RESULT: The outcome was shown to be successful and the patient can void with a good flow after removing the catheter. The graft was well vascularized and the glans was cosmetically acceptable. There was no recurrent stricture after 12 months follow up. CONCLUSION: This novel technique is simple, effective and may be beneficial as it obviates the need for complex reconstruction. However, this technique would only be feasible in selected patients with suitable conditions of meatal opening and those with a short segment of stricture.

Endometriosis in the Canal of Nuck presenting with suprapubic pain: A case report and literature review.

The endometriosis in the Canal of Nuck is a rare condition. Most patients exhibited groin swelling but this case present with a rare condition which is suprapubic pain for 2 years. This case is a 34-year-old healthy woman had developed chronic intermittent right suprapubic pain for 2 years. Physical examination revealed a 2-cm. Reducible mass at right suprapubic area. MRI was performed and the result showed a 2.7 × 1.3 × 4.9 cm-size multiloculated cystic mass located near the round ligament of the uterus which was consistent with a Nuck's canal cyst. The definitive treatment was done by excision of mass.