The promise of regenerative medicine in the treatment of urogenital disorders.

Polymers and scaffolds are the most significant tools in regenerative medicine. Urogenital disorders are an important group of diseases that greatly affect the patient's life expectancy and quality. Reconstruction of urogenital defects is one of the current challenges in regenerative medicine. Regenerative medicine, as well as tissue engineering, may offer suitable approaches, while the tools needed are appropriate materials and cells. Autologous urothelial cells obtained from biopsy, bone marrow-derived stem cells, adipose stem cells and urine-derived stem cells that expressed mesenchymal cell markers are the cells that mainly used. In addition, two main types of biomaterials mainly exist; synthetic polymers and composite scaffolds that are biodegradable polymers with controllable properties and naturally derived biomaterials such as extracellular matrix components and acellular tissue matrices. In this review, we present and evaluate the most appropriate and suitable scaffolds (naturally derived and synthetic polymers) and cells applied in urogenital reconstruction.

Endoscopy as an Adjunct to Image-Guided Interventions: A New Frontier in Interventional Radiology.

Endoscopy is an underutilized technique in the practice of interventional radiology. The objectives of this article are to discuss potential uses of interventional radiology-operated endoscopy and to outline basic endoscopy setup and equipment uses. Endoscopy represents a new frontier to the fluoroscopically-guided procedures in biliary, gastrointestinal, and genitourinary disease that interventional radiologists commonly perform. It shows promise to improve interventional radiology procedure success rates and reduce procedure-associated risk for patients. Endoscopy has been traditionally performed by gastroenterologists and urologists and is relatively new in the practice of interventional radiology. The hand-eye coordination and manual dexterity required to perform standard image-guided procedures places interventional radiologists in a unique position to introduce endoscopy into standard practice. A focused and collaborative effort is needed by interventional radiologists to learn the techniques required to successfully integrate endoscopy into practice.

Beyond the Bile Duct: Advanced IR Endoscopic Interventions Involving the Gastrointestinal, Genitourinary, and Musculoskeletal Systems.

Endoscopy is a technique used by interventional radiology (IR) in only a few centers throughout the United States. When used by IR, endoscopy is most well-known for its role in the treatment of hepatobiliary disease. However, its use with relation to pathology involving the gastrointestinal, genitourinary, and musculoskeletal systems is gaining momentum among IR. The purpose of this article is to demonstrate the potential benefits of IR endoscopy in nonbiliary intervention. A literature review, not requiring IRB approval, was performed via PubMed and Ovid Medline databases using the search terms "interventional radiology-operated endoscopy," "interventional endoscopy," "interventional radiology," "genitourinary," and "gastrointestinal." Literature describing IR endoscopy involving the gastrointestinal, genitourinary, and musculoskeletal systems were identified and described. Nine peer-reviewed articles were identified. While few studies were identified, a general theme suggesting a synergistic relationship between IR and endoscopy was noted. More studies are needed to better understand the role of endoscopy as a technique in the IR suite.

Intra-abdominal Complications After Pediatric Kidney Transplantation: Incidence and Risk Factors.

BACKGROUND: The incidence and types of intra-abdominal complications after pediatric transplantation are not well established, and specific risk groups have not been clearly identified. METHODS: A retrospective chart review of all pediatric transplant recipients between 1995 and 2016 was undertaken. Intra-abdominal complications were grouped into 4 categories: fluid collections, gastrointestinal, vascular, and urogenital. Donor, recipient, and transplant characteristics were evaluated using univariate and multivariate logistic regressions. RESULTS: There were 146 transplants meeting the inclusion criteria. The mean follow-up time was 4.6 ± 3.7 years (range, 0.3-18 y). The mean weight at transplantation was 31.5 ± 16.5 kg (range, 9-78), with 24 (16%) recipients being <15 kg and 23% younger than 5 years. Thirty-four (23%) patients had previous abdominal surgery. There were 32 complications identified in 27 (18%) transplant recipients. Fluid collections requiring surgical drainage developed in 9 (6.2%), gastrointestinal surgical complications in 12 (8.2%), vascular complications in 5 (3.5%), and urogenital complications in 6 (4.1%). There were only 3 graft losses due to abdominal complications, all after renal vein thrombosis. Weight <15 kg at the time of transplant (P = 0.016), previous abdominal surgery (P = 0.047), and intraperitoneal surgical technique (P = 0.008) were risk factors in the univariate analysis using Cox regression models, whereas only weight <15 kg (P = 0.003) and previous abdominal surgery (P = 0.008) were retained in the multivariate analysis. CONCLUSIONS: Intraabdominal complications occur in almost 1 in 5 pediatric renal transplant recipients. Weight <15 kg and previous abdominal surgery are risk factors for developing such complications.

Urologic Emergencies.

Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis, whereas imaging is increasingly used to confirm diagnoses. Acute urinary retention should be relieved with Foley placement. Penile emergencies include paraphimosis, which can be treated by foreskin reduction, whereas penile fracture and priapism require urologic intervention. Fournier gangrene and testicular torsion are scrotal emergencies requiring emergent surgery. Nephrolithiasis, although painful, is not an emergency unless there is concern for concomitant urinary tract infection, both ureters are obstructed by stones, or there is an obstructing stone in a solitary kidney.

Genito-urinary sequelae after carcinological rectal resection: What to tell patients in 2017.

Although we have seen revolutionary changes with multi-disciplinary management of patients with rectal cancer, the evaluation of genito-urinary sequelae remains of great concern. Precise pre-operative evaluation with validated scores allows detection of urinary disorders in 16 to 23% of patients, and sexual disorders in nearly 35% of men and 50% of women. Regardless of the surgical approach, it is fundamental to respect the autonomic innervation during total mesorectal excision in order to prevent these sequelae. Identification of these nerves can be facilitated by intra-operative neuro-stimulation. In spite of these precautions, de novo urinary sequelae are observed in nearly 33% of patients and bladder evacuation disorders in 25% of patients. Advanced age, pre-operative urinary disorders, female gender, and abdomino-perineal resection are independent risk factors for urinary sequelae. Early post-operative urodynamic abnormalities might be predictive of these sequelae and justify early physiotherapy. Likewise, sexual sequelae such as erectile and/or ejaculatory disorders, dyspareunia and lubrication deficits result in de novo cessation of sexual activity in 28% of men and 18% of women. Advanced age, neo-adjuvant radiation therapy, and abdomino-perineal resection are independent risk factors for sexual dysfunction. Pharmacotherapy with sildenafil has proven useful in the treatment of erectile disorders. Genito-urinary and ano-rectal sequelae occur concomitantly in more than one of ten patients, suggesting a potential common pathophysiology.

Genitourinary Complications of Diabetes Mellitus: An Overview of Pathogenesis, Evaluation, and Management.

BACKGROUND: Diabetes mellitus is a vastly prevalent metabolic disorder with escalating global health concerns. Particularly when mismanaged, chronic micro- and macrovascular complications may highly impair physiological systems while immunodeficiency disposes us to infection. OBJECTIVE: We investigate infections, localized complications, and neoplasms of the genitourinary system secondary to the chronic complications of diabetes mellitus in males and females. METHOD: A comprehensive MEDLINE® search was guided using key words relevant to diabetes mellitus and the genitourinary system. RESULTS: Pathogen-friendly environments may implicate the sequelae of urinary tract and genital mycotic infections, potentially generating necrosis, abscess, and other inflammatory complications, which may present concomitantly with neurogenic and/or vasculogenic dysfunction to further exacerbate an existing genitourinary condition. Manifestations of the adrenal, renal, and genital organs and tissues are discussed as they relate to vascular, immunodeficient, and other hyperglycemic complications of the diabetic state. Among those, chronic kidney disease and cystopathy are the most prevailing and detrimental. Though studies have connected diabetes to either an increased risk of developing or poor prognosis of bladder, renal, prostate, endometrial, and cervical cancers, the explicit biological relationships are as of yet inconclusive. CONCLUSION: Despite the availability of precise treatments to ameliorate most presently reviewed conditions, particularly urinary tract and genital mycotic infection-related sequelae, reversing permanent vascular damage remains a great challenge. Leading a healthier lifestyle and managing diabetes mellitus with a patient-centric approach from the outset are the most putative methods for preventing critical long-term genitourinary manifestations of diabetes mellitus.

Management of Hormone Deprivation Symptoms After Cancer.

Cancer survivors often experience symptoms related to hormone deprivation, including vasomotor symptoms, genitourinary symptoms, and sexual health concerns. These symptoms can occur due to natural menopause in midlife women, or they can be brought on by oncologic therapies in younger women or men. We searched PubMed for English-language studies from January 1990 through January 2016 to identify relevant articles on the management of hormone deprivation symptoms, including vasomotor, genitourinary, and sexual symptoms in patients with cancer. The search terms used included hormone deprivation, vasomotor symptoms, hot flash, vaginal dryness, sexual dysfunction, and breast cancer. This manuscript provides a comprehensive description of data supporting the treatment of symptoms associated with hormone deprivation.

Combined Therapy With Adipose-Derived Mesenchymal Stem Cells and Ciprofloxacin Against Acute Urogenital Organ Damage in Rat Sepsis Syndrome Induced by Intrapelvic Injection of Cecal Bacteria.

UNLABELLED: We hypothesized that combined treatment with autologous adipose-derived mesenchymal stem cell (ADMSC) and ciprofloxacin is superior to ciprofloxacin only in reducing sepsis-induced urogenital organ damage and mortality in rat sepsis syndrome (SS) caused by intrapelvic injection of cecal bacteria (1.0 × 10(4) cells per milliliter; total, 5.0 ml). Male Sprague-Dawley rats (n = 60) equally divided into group 1 (sham-control), group 2 (SS), group 3 (SS-ADMSC [5.0 × 10(5) intravenously at 0.5, 6, and 18 hours after sepsis induction]), group 4 (SS-ciprofloxacin [3.0 mg/kg, b.i.d.] for 5 days), and group 5 (SS-ADMSC-ciprofloxacin) were sacrificed by day 5. Mortality rate and creatinine level were highest in group 2 and lowest in group 1 and significantly higher in groups 3 and 4 than those in group 5, but there was no difference between groups 3 and 4 (all p < .005). The kidney injury score, inflammatory biomarker expressions at protein (tumor necrosis factor-1α, nuclear factor-κB, matrix metallopeptidase-9, regulated on activation, normal T-cell expressed and secreted, interleukin-1ß) and cellular (CD14+, migratory inhibitor factor positive, CD68+) levels in kidneys and urinary bladder were lowest in group 1 and highest in group 2, higher in group 4 than in groups 3 and 5, and higher in group 3 than in group 5 (all p < .001). Protein expressions of apoptosis (Bax, cleaved caspase 3 and poly[ADP-ribose] polymerase 1, p21 protein [Cdc42/Rac]-activated kinase 2) and oxidative stress (oxidized protein, NADPH oxidase (NOX)-1, NOX-2) in these organs showed an identical pattern compared with that of inflammation in all groups (all p < .001). In conclusion, ADMSC-assisted ciprofloxacin therapy offered an additional benefit by reducing acute urogenital organ damage in rat. SIGNIFICANCE: Autologous adipose-derived mesenchymal stem cell-assisted ciprofloxacin therapy offered an additional benefit by reducing acute urogenital organ damage in rats.

Current Practice Patterns Among Members of the American Urological Association for Male Genitourinary Lichen Sclerosus.

OBJECTIVE: To determine the practice patterns of urologists who treat male genitourinary lichen sclerosus (MGU-LS) via a national web-based survey distributed to American Urological Association members. METHODS: A 20-question survey was collected from a random sample of American Urological Association members. Respondents answered questions on their practice patterns for MGU-LS diagnosis, treatment of symptomatic urethral stricture disease, surveillance, and follow-up. RESULTS: In total, 309 urologists completed the survey. The majority of respondents reported practicing more than 20+ years (37.5%) within an academic (31.7%) or group practice (31.1%) setting. The majority of respondents saw 3-5 men with MGU-LS per year (32.7%). The most common locations of MGU-LS involvement included the glans penis (66.2%), foreskin (26.3%), and/or the urethra (5.8%). Respondent first-line treatment for urethral stricture disease was direct visual internal urethrotomy (26.6%) and second-line treatment was referral to subspecialist (38.4%). After controlling for the number of patients evaluated with MGU-LS per year, those with reconstructive training were more likely to perform a primary urethroplasty for men with symptomatic urethral stricture disease (adjusted odds ratio 13.1, 95% confidence interval 5.1-33.8, P < .001). They were also more likely to counsel men on the associated penile cancer risks (adjusted odds ratio 4.6, 95% confidence interval 1.7-12.5, P < .01). CONCLUSION: Reconstructive urologists evaluate the most number of patients with MGU-LS and are more likely to perform primary urethroplasty for urethral stricture disease. Men with MGU-LS should be referred to a reconstructive urologist to understand the full gamut of treatment options.

[Frequent uro-geriatric symptoms : helpful tools for general practitioners]. / L'urogériatrie du médecin généraliste.

Each developed country faces an aging population. Increase of age rises the risk to develop urologic pathology especially in men. Routine investigation and diagnostic of urologic pathology important, however must take into account the patient in his globality (including age, comorbidities, drug medication as well as sociocultural environment). The aim of this article is to help the general practitioner in taking decisions with frequent uro-geriatric symptoms. Bladder catheterization remains an invasive treatment and indication should be regularly re-evaluated. Urinary infections must be distinguished from bacterial colonisations, with some exceptions, don't need any specific treatment. We will resume two algorithms on the management of hematuria and the management of prostate cancer suitable for the elderly.

Tout pays développé voit vieillir sa population et le risque de développer une pathologie urologique augmente avec l'âge, notamment chez les hommes. La prise en charge d'un symptôme urologique doit prendre en compte la personne âgée dans sa globalité. Cet article rappelle les éléments principaux de la gestion initiale d'un prostatisme : dépister les symptômes, débuter un traitement et surtout l'adapter au quotidien du patient. La sonde urinaire est un traitement invasif dont l'indication doit être remise en cause. Les infections urinaires sont à différencier des colonisations bactériennes qu'il ne faut pas traiter, sauf dans certaines situations. Nous reprendrons deux arbres décisionnels sur la prise en charge de l'hématurie et d'un cancer prostatique adaptés à la personne âgée.

[Congenital bilateral absence of vas deferens: From diagnosis to assisted reproductive techniques - the experience of three centers]. / Absence bilatérale des canaux déférents : du diagnostic à l'assistance médicale à la procréation. Expérience de 3 centres.

OBJECTIVES: To review the management with assisted reproductive technologies (ART) of men with congenital bilateral absence of vas deferens (CBAVD), associated with cystic fibrosis or not, after surgical retrieval [epididymal aspiration (MESA) or testicular biopsy (TESE)]. METHODS: Multicenter retrospective study made of 2 groups: CBAVD and cystic fibrosis (CF) or CBAVD only (CF-RD). Two centers performed MESA (Brest and Nantes) and one TESE (Rennes). Sperm numeration, motility, vitality, morphology and nuclear maturity were measured in both centers performing MESA. Fertilization rate (TF) and cumulated progressive pregnancy rate by retrieved oocyte (TGC) were compared between centers following ART. RESULTS: Ninety patients underwent surgical retrieval between January 1996 and March 2013, 30 in the CF group and 60 in the CF-RD group. Semen parameters were comparable between groups and centers. Fifty-eight (22 in the CF group and 36 in the CF-RD group) patients received ART between April 1996 and October 2014. TF was 50% and 52% and TGC 26% and 32% in the CF group and CF-RD groups, respectively. The results did not differ between groups but TGC was higher in Rennes than in the other two centers. CONCLUSION: Both semen parameters and ART results are comparable and similar to those reported in the literature. As shown by the results obtained in Rennes, TESE seems to be more effective.

Calcification of the vas deferens and seminal vesicles: a review.

INTRODUCTION: Calcification of the vas deferens and seminal vesicles is a rare condition of unknown incidence. It has been described in association with diabetes, hyperparathyroidism and genitourinary tuberculosis, amongst other conditions. Little is known about the clinical significance and management of this condition. We review the literature in an effort to find answers about an entity that is frequently appreciated as an incidental finding. MATERIALS AND METHODS: An electronic database search was performed (Medline) using the key words: vas deferens; seminal vesicles; calcification, alone or in combination. Articles were selected according to relevance and quality of evidence. RESULTS: The search included published manuscripts between 1960 and 2012. A total of 17 relevant publications were identified. The majority were written in the English language and mostly consisted of case presentations and reports of radiologic findings. CONCLUSION: Calcification of the vas deferens and seminal vesicles is a rare condition. However, it may be implicated in male factor infertility and symptoms from the urogenital tract. Treatment should be directed towards the underlying cause on an individual basis. It is unknown whether control of the primary process has any effects on the histopathological appearance of the ducts and/or their improvement of function.

Virus integration and genome influence in approaches to stem cell based therapy for andro-urology.

Despite the potential of stem cells in cell-based therapy, major limitations such as cell retention, ingrowth, and trans-differentiation after implantation remain. One technique for genetic modification of cells for tissue repair is the introduction of specific genes using molecular biology techniques, such as virus integration, to provide a gene that adds new functions to enhance cellular function, and to secrete trophic factors for recruiting resident cells to participate in tissue repair. Stem cells can be labeled to track cell survival, migration, and lineage. Increasing evidence demonstrates that cell therapy and gene therapy in combination remarkably improve differentiation of implanted mesenchymal stromal cells (MSCs), revascularization, and innervation in genitourinary tissues, especially to treat urinary incontinence, erectile dysfunction, lower urinary tract reconstruction, and renal failure. This review discusses the benefits, safety, side effects, and alternatives for using genetically modified MSCs in tissue regeneration in andro-urology.

Retroperitoneal disorders associated with IgG4-related autoimmune pancreatitis.

IgG4-related autoimmune pancreatitis is frequently accompanied by relevant lesions in the genitourinary tract and retroperitoneal organs, which cause various clinical problems, ranging from non-specific back pain or bladder outlet obstruction to renal failure. The diagnosis of IgG4-related retroperitoneal fibrosis requires a multidisciplinary approach, including serological tests, histological examination, imaging analysis, and susceptibility to steroid therapy. Radiological examinations are helpful to diagnose this condition, but surgical resection is occasionally unavoidable to exclude malignancy, particularly for patients with isolated retroperitoneal involvement. Steroid therapy is the treatment of choice for this condition, the same as for other manifestations of IgG4-related disease. For patients with severe ureteral obstruction, additional ureteral stenting needs to be considered prior to steroid therapy to preserve the renal function. Some papers have suggested that IgG4-related disease can affect male reproductive organs including the prostate and testis. IgG4-related prostatitis usually causes lower urinary tract symptoms, such as dysuria and pollakisuria. Patients sometimes state that corticosteroids given for IgG4-related disease at other sites relieve their lower urinary tract symptoms, which leads us to suspect prostatic involvement in this condition. Because of the limited number of publications available, further studies are warranted to better characterize IgG4-related disease in male reproductive organs.

[Urological diseases most frequently involved in medical professional liability claims]. / Patologías urológicas más frecuentemente implicadas en las reclamaciones por responsabilidad profesional médica.

Clinical safety and medical professional liability are international major concerns, especially in surgical specialties such as urology. This article analyzes the claims filed at the Council of Medical Colleges of Catalonia between 1990 and 2012, exploring urology procedures. The review of the 173 cases identified in the database highlighted the importance of surgical procedures (74%). Higher frequencies related to scrotal-testicular pathology (34%), especially testicular torsion (7.5%) and vasectomy (19.6%), and prostate pathology (26 %), more specifically the surgical treatment of benign prostatic hyperplasia (17.9%). Although urology is not among the specialties with the higher frequency of claims, there are special areas of litigation in which it is advisable to implement improvements in clinical safety.

[Multiple sclerosis and pelviperineology: Urinary and sexual dysfunctions and pregnancy]. / Sclérose en plaques et pelvipérinéologie : troubles vésico-sphinctériens, sexuels et maternité

GOAL: The aim was to review the literature on genito-urinary dysfunction in multiple sclerosis (MS). MATERIAL: A literature review through the PubMed library until August, 31 2013 was carried out using the following keywords: multiple sclerosis and neurogenic bladder, neuropathic bladder, bladder, management, follow-up, urological complications, urological treatment, sexual dysfunction, female sexual function, male sexual function, erectile dysfunction, anorectal, faecal, constipation, bowel, pregnancy, parturition, delivery, breast-feeding. RESULTS: Genito-urinary dysfunction is frequent in MS (35-90%) and may happen soon in the disease. Urinary symptoms (10-90%) are manifold resulting in a quality of life alteration and the onset of complications in 30% of the cases requiring a long-term follow-up. Sexual dysfunctions (35-87%) are also manifold affecting all the sexuality domains in men and women. Except the phosphodiesterase V inhibitors, few treatments have been assessed in this population. Pregnancy is nowadays considered as beneficial resulting in a disease slow-down and the lack of disease worsening despite an increase in disease relapse during the post-partum first quarter. It seems to be better to consider getting pregnant after at least one year without any relapse and to emphasize an exclusive breast-feeding. CONCLUSION: Urinary and sexual dysfunctions are frequent in MS. A transdisciplinary approach including the neurologist and pelviperineology specialists facilitates a disability adapted early management.