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ABSTRACT Objective: Bladder wall thickness (BWTh) measurements and Nerve Growth Factor (NGF) /creatinine (Cr) values, as noninvasive tools, were found to predict daytime voiding problems in children with overactive bladder (OAB). The goal of this research was to examine if bladder wall thickness together with urine NGF/Cr could be a clinical utility in treatment outcome of OAB in children. Patients and Methods: A total of 60 children with OAB, (Group 1; n=40) and healthy normal controls (Group 2; n=20), aged 6-14 years old were involved in this prospective study. Children were evaluated with detailed history and physical examination, including neurologic examination, and were asked to complete a self-reported questionnaire and a 3-day bladder diary with the aid of their parents. Uroflowmetry was performed in all cases. Urinary nerve growth factor levels were measured by the ELISA and BWTh was measured trans-abdominally by one uro-radiologist specialized in pediatric ultrasonography. Urinary NGF levels were normalized by urinary creatinine levels and compared among all subgroups. Children with OAB received urotherapy as first line treatment at least for three months. 18 children refractory to urotherapy received anticholinergic therapy defined as group 3. Results: The median age of the study group was 10 (range 6 to 16). After urotherapy, 22 children had similar BWTh and NGF/Cr values compared to controls. (2.75 ± 1.15; 2.40 ± 1.00 mm; p=0.86 and 1.02 ± 0.10; 0.78 ± 0.15; p=0.12, respectively). After anticholinergic treatment, BWTh levels (2.25 ± 0.90; 2.40 ± 1.00 mm; p=0.94) and NGF/Cr values (0.95 ± 0.10; 0.78 ± 0.15; p=0.42, respectively) had no significantly difference compared to controls (Group 2). In receiver operating characteristic analysis, bladder wall thickness was found to have sensitivity of 85% and specificity of 84.2% (3,20 AUC, 913; 95 %) and NGF/Cr had sensitivity of 90% and specificity of 92.1% (1,595; AUC, 947; 95 %) in predicting treatment outcome in children with OAB. Conclusions: Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, could guide outcomes in the treatment of children with overactive bladder.
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OBJECTIVE: Bladder wall thickness (BWTh) measurements and Nerve Growth Factor (NGF) /creatinine (Cr) values, as noninvasive tools, were found to predict daytime voiding problems in children with overactive bladder (OAB). The goal of this research was to examine if bladder wall thickness together with urine NGF/Cr could be a clinical utility in treatment outcome of OAB in children. PATIENTS AND METHODS: A total of 60 children with OAB, (Group 1; n=40) and healthy normal controls (Group 2; n=20), aged 6-14 years old were involved in this prospective study. Children were evaluated with detailed history and physical examination, including neurologic examination, and were asked to complete a self-reported questionnaire and a 3-day bladder diary with the aid of their parents. Uroflowmetry was performed in all cases. Urinary nerve growth factor levels were measured by the ELISA and BWTh was measured trans-abdominally by one uro-radiologist specialized in pediatric ultrasonography. Urinary NGF levels were normalized by urinary creatinine levels and compared among all subgroups. Children with OAB received urotherapy as first line treatment at least for three months. 18 children refractory to urotherapy received anticholinergic therapy defined as group 3. RESULTS: The median age of the study group was 10 (range 6 to 16). After urotherapy, 22 children had similar BWTh and NGF/Cr values compared to controls. (2.75 ± 1.15; 2.40 ± 1.00 mm; p=0.86 and 1.02 ± 0.10; 0.78 ± 0.15; p=0.12, respectively). After anticholinergic treatment, BWTh levels (2.25 ± 0.90; 2.40 ± 1.00 mm; p=0.94) and NGF/Cr values (0.95 ± 0.10; 0.78 ± 0.15; p=0.42, respectively) had no significantly difference compared to controls (Group 2). In receiver operating characteristic analysis, bladder wall thickness was found to have sensitivity of 85% and specificity of 84.2% (3,20 AUC ,913; 95 %) and NGF/Cr had sensitivity of 90% and specificity of 92.1% (1,595; AUC ,947; 95 %) in predicting treatment outcome in children with OAB. CONCLUSIONS: Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, could guide outcomes in the treatment of children with overactive bladder.
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Vejiga Urinaria Hiperactiva , Adolescente , Biomarcadores/orina , Niño , Humanos , Factor de Crecimiento Nervioso/uso terapéutico , Factor de Crecimiento Nervioso/orina , Estudios Prospectivos , Resultado del Tratamiento , Vejiga Urinaria/diagnóstico por imagen , Vejiga Urinaria Hiperactiva/tratamiento farmacológicoRESUMEN
PURPOSE: To discuss whether concealed penis after circumcision lowers perimeatal urethral and glanular sulcus uropathogenic bacterial colonization in healthy boys with no urinary tract problems and prevents attacks of febrile urinary tract infections in non-healthy boys with defined urinary tract abnormalities. Materials and Methods: This case-control study was conducted in Ibn-i Sina Hospital and retrospectively collected data of 471 boys were analyzed. All patients were scanned for any urinary tract abnormality and those with any defined abnormalities were classified as non-healthy group. (123 patients) Non-healthy patients were divided into two subgroups as concealed (n:31) and non-concealed (n:92) penis after circumcision. Healthy patients with no urinary problems were divided into three groups as circumcised without concealed penis (n:144), with concealed penis after circumcision (n:104) and uncircumcised control group (n:100). Bacterial cultures were obtained from both periurethral meatal and glanular sulcus areas by adhering strictly to the rules of obtaining bacterial culture to avoid false-positive or negative culture results. Also only uropathogenic bacterias were evaluated, irrelevant results were excluded. Results: Mean age was similar in healthy population. Comparison of three groups showed that there was a significant difference in both cultures.(P = .026 for periurethral meatal region, P = .039 for glanular sulcus region) In post hoc analysis, non-concealed group had a lower rate of culture positivity in both areas compared to other groups. Mean age was also similar in non-healthy population. Mean follow-up period was 18.2 months. Patients with concealed penis after circumcision had a significantly higher number of febrile UTI attacks (20 attacks in 8 patients vs 7 attacks in 5 patients) compared to non-concealed group. (P = .019) All febrile UTI attacks except one in this group occurred below the age of 12 months. A total of 10 patients in both healthy and non-healthy groups had postoperative hemorrhage after circumcision and only 1 patient had a wound infection. Conclusion: Concealed penis after circumcision does not lower perimeatal urethral and glanular sulcus uropathogenic bacterial colonization in healthy patients and does not protect unhealthy patients from febrile urinary tract infection attacks. If circumcision is planned, concealed penis should be avoided and also parents should be informed about the possible risks due to concealed penis before the procedure, particularly in patients with urinary tract abnormalities.
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Bacterias/aislamiento & purificación , Circuncisión Masculina , Complicaciones Posoperatorias , Infección de la Herida Quirúrgica , Infecciones Urinarias , Estudios de Casos y Controles , Niño , Circuncisión Masculina/efectos adversos , Circuncisión Masculina/métodos , Humanos , Masculino , Pene/microbiología , Pene/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/prevención & control , Hemorragia Posoperatoria/diagnóstico , Hemorragia Posoperatoria/etiología , Ajuste de Riesgo , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/prevención & control , Resultado del Tratamiento , Infecciones Urinarias/etiología , Infecciones Urinarias/microbiología , Infecciones Urinarias/prevención & controlRESUMEN
INTRODUCTION: The aim of this study was to evaluate the efficacy, safety and tolerability of intravesical hyaluronic acid (HA), chondroitin sulfate (CS) and combination therapies (HA+CS) for patients with bladder pain syndrome (BPS) - interstitial cystitis (IC) during a 24 months follow-up period. MATERIAL AND METHODS: The study was conducted with a prospective, randomized and double-blinded design. A total of 72 patients were divided into three groups as HA, CS and combination group. Outpatient visits were performed at the begining of the study and at every 3rd month thereafter. Both objective parameters included in 3 day micturition diary such as number of micturitions per 24 hours, volume voided in each micturition and self-reported questionnaires such as Patient Perception of Bladder Condition Scale, Visual Analog Scale, Pain Urgency Frequency Questionnaire, Interstitial Cystitis Symptom and Problem Index, Health Related Quality of Life (HRQoL) were used to assess the efficacy of three different agents. Safety was defined as any adverse event beginning or worsening in the study and reported in each visit. RESULTS: All groups showed a significant improvement both in the parameters included in the 3 day micturition diary and self-reported questionnaires compared to the baseline values or scores recorded at the beginning of the study. Our primary end point was improvement in HRQoL score. The combination therapy was superior to both of the monotherapies in terms of improvement in HRQoL score and the difference was statistically significant (p = 0.02). CONCLUSIONS: Combination therapy provides better results than the monotherapies to obtain symptomatic relief in patients with BPS/IC. Meta-analysis of different well-designed studies are required for more definitive results.
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ABSTRACT Purpose To evaluate the efficacy and tolerability of mirabegron in females with overactive bladder (OAB) symptoms after surgical treatment for stress urinary incontinence (SUI). Materials and Methods The study was conducted with a prospective, randomized and double-blinded design. 62 patients over the age of 40 who met the inclusion-exclusion criterias of the study were enrolled and randomly divided into two groups as Group A (mirabegron 50mg) and B (solifenacin 5mg). Patients were compared based on efficacy of treatment [Patient Perception of Bladder Condition (PPBC) scale and micturition diaries], safety of treatment (heart rate, systolic and diastolic blood pressure, adverse events), number of micturitions per day, patient's satisfaction status after treatment [Visual Analog Scale(VAS)] and quality of life. Results The mean age of the population was 48.2±3.8 years and the duration of OAB symptoms was 5.9±2.9 months. Baseline values for the mean number of micturitions, volume voided in each micturition, nocturia episodes, urgency and urgency incontinence episodes were 15.3±0.34, 128±3.88mL, 3.96±1.67, 5.72±1.35 and 4.22±0.69, respectively. After treatment, values for these parameters were 11.7±0.29, 164.7±2.9mL, 2.25±0.6, 3.38±0.71, 2.31±0.49 respectively. Quality of life score, symptom bother score, VAS for treatment satisfaction score, PPBC score after treatment were 66.1±0.85, 43.7±0.77, 4.78±0.14, 4.78±0.14, respectively. There were no significant differences between two groups on any parameter. However, mirabegron showed better tolerability than solifenacin, particularly after 6 months. Conclusion Mirabegron is safe, effective and tolerable in the long-term treatment of females with OAB symptoms after surgery for stress urinary incontinence.
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Humanos , Femenino , Adulto , Tiazoles/uso terapéutico , Incontinencia Urinaria de Esfuerzo/cirugía , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Agonistas de Receptores Adrenérgicos beta 3/uso terapéutico , Acetanilidas/uso terapéutico , Calidad de Vida , Valores de Referencia , Incontinencia Urinaria de Esfuerzo/fisiopatología , Método Doble Ciego , Estudios Prospectivos , Reproducibilidad de los Resultados , Resultado del Tratamiento , Antagonistas Muscarínicos/uso terapéutico , Vejiga Urinaria Hiperactiva/fisiopatología , Escala Visual Analógica , Succinato de Solifenacina/uso terapéutico , Persona de Mediana EdadRESUMEN
PURPOSE: To evaluate the efficacy and tolerability of mirabegron in females with overactive bladder (OAB) symptoms after surgical treatment for stress urinary incontinence (SUI). MATERIALS AND METHODS: The study was conducted with a prospective, randomized and double-blinded design. 62 patients over the age of 40 who met the inclusion-exclusion criterias of the study were enrolled and randomly divided into two groups as Group A (mirabegron 50mg) and B (solifenacin 5mg). Patients were compared based on efficacy of treatment [Patient Perception of Bladder Condition (PPBC) scale and micturition diaries], safety of treatment (heart rate, systolic and diastolic blood pressure, adverse events), number of micturitions per day, patient's satisfaction status after treatment [Visual Analog Scale(VAS)] and quality of life. RESULTS: The mean age of the population was 48.2±3.8 years and the duration of OAB symptoms was 5.9±2.9 months. Baseline values for the mean number of micturitions, volume voided in each micturition, nocturia episodes, urgency and urgency incontinence episodes were 15.3±0.34, 128±3.88mL, 3.96±1.67, 5.72±1.35 and 4.22±0.69, respectively. After treatment, values for these parameters were 11.7±0.29, 164.7±2.9mL, 2.25±0.6, 3.38±0.71, 2.31±0.49 respectively. Quality of life score, symptom bother score, VAS for treatment satisfaction score, PPBC score after treatment were 66.1±0.85, 43.7±0.77, 4.78±0.14, 4.78±0.14, respectively. There were no significant differences between two groups on any parameter. However, mirabegron showed better tolerability than solifenacin, particularly after 6 months. CONCLUSION: Mirabegron is safe, effective and tolerable in the long-term treatment of females with OAB symptoms after surgery for stress urinary incontinence.
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Acetanilidas/uso terapéutico , Agonistas de Receptores Adrenérgicos beta 3/uso terapéutico , Tiazoles/uso terapéutico , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Incontinencia Urinaria de Esfuerzo/cirugía , Adulto , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Antagonistas Muscarínicos/uso terapéutico , Estudios Prospectivos , Calidad de Vida , Valores de Referencia , Reproducibilidad de los Resultados , Succinato de Solifenacina/uso terapéutico , Resultado del Tratamiento , Vejiga Urinaria Hiperactiva/fisiopatología , Incontinencia Urinaria de Esfuerzo/fisiopatología , Escala Visual AnalógicaRESUMEN
PURPOSE: To compare of changes in glomerular filtration rate (GFR) in patients who underwent radical cystectomy (RC) and multimodal treatment (MMT). MATERIALS AND METHODS: We identified 472 consecutive patients who underwent RC or treated with MMT for muscle invasive bladder cancer (MIBC) at our institution, between January 1995 and December 2010. After ex-cluding the patients who died within 5 years or without 5 years of follow-up, 175 and 59 patients who were treated with RC and MMT, respectively were included to the study. GFR was measured before treatment and every 6 months after treatment till the end of 60th month. RESULTS: The mean age and mean baseline GFR were 66.5±5.7 years and 85.1±18.2 mL/min/1.73m2, respectively for all patients. We detected statistically significant higher decrease rates for GFRs in MMT group compared to RC group at every follow up period till 42nd month. Renal function decreasing was found to be more prominent during first year of follow-up (79.1 to 65.9 mL/min/1.73m2) in MMT group. However, GFR decreased more reg-ularly in RC group (~4 mL/min/1.73m2 per year). MMT, lower baseline GFR, Diabetes Mellitus, hypertension, and ureteroenteric anastomotic stricture development were associated with low GFR under 60 and 45 mL/min at the end of five years. CONCLUSION: Decreased renal function is noted in many MIBC patients after RC or MMT in the long-term fol-low-up. Renal function deterioration is more prominent within the first year after MMT.
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Tasa de Filtración Glomerular , Riñón/fisiopatología , Neoplasias de la Vejiga Urinaria/terapia , Anciano , Terapia Combinada , Cistectomía , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugíaAsunto(s)
Humanos , Masculino , Conducta Sexual , Matrimonio , Neoplasias de la Próstata , Turquía , Mar NegroAsunto(s)
Matrimonio , Conducta Sexual , Mar Negro , Humanos , Masculino , Neoplasias de la Próstata , TurquíaRESUMEN
OBJECTIVE: In this study, we aimed to evaluate the efficacy of tadalafil in the management of erectile dysfunction in patients under dutasteride medication for bladder outlet obstruction. MATERIAL AND METHODS: In this study the data of consecutive patients that admitted to our outpatient clinics treated with dutasteride for bladder outlet obstruction and tadalafil (10 or 20 mg on demand) for concomitant complaint of erectile dysfunction (ED) between October 2013 and March 2016 were evaluated. An age-matched control group of patients treated with tadalafil for ED but did not receive any other medication for either lower urinary tract symptoms (LUTS) or ED was also included. Groups were compared for tadalafil efficacy with International Index of Erectile Function (IIEF) scores. RESULTS: Each one of the dutasteride and control groups included 104 patients. The groups were similar for pretreatment IIEF score, serum cholesterol, low-density lipoprotein (LDL), triglyceride and testosterone measurements. The number of hypertensive patients was comparable between two groups but the number of diabetic patients were significantly higher in the control group. IIEF score improved significantly in both groups following tadalafil treatment but the difference between the two groups was not statistically significant. CONCLUSION: Tadalafil treatment provides significant improvement in erectile functions of patients under dutasteride treatment for bladder outlet obstruction. However, the current study does not focus on a population of dutasteride induced ED and therefore a further prospective study on this issue would be helpful.
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OBJECTIVE: Hydronephrosis developing following ureteroscopy (URS) is an important issue associated with the long-term postoperative renal functions. Studies investigating the role of postoperative imaging revealed conflicting results. In this study, we aimed to determine the incidence and predictors of hydronephrosis following semirigid URS. MATERIAL AND METHODS: We evaluated the results of 455 patients who underwent U RS a nd postoperative imaging with non-contrast computed tomography (CT). Primary endpoints of the study were to determine the frequency of development of hydronephrosis and factors associated with the development of hydronephrosis. Logistic regression analysis was used to define factors effecting on the development of hydronephrosis. RESULTS: Postoperative non-contrast CT revealed hydronephrosis in 81 (17.8%) patients. Stone-free status was achieved in 415 (91.2%) patients. Univariate analysis revealed history of ipsilateral URS (p=0.001), duration of operation (p=0.022), presence of multiple stones (p=0.001), and occurrence of a renal colic episode postoperatively (p=0.013) as the parameters associated with increased risk of postoperative hydronephrosis. In the multivariate analysis, history of ipsilateral URS (OR: 2.724, p=0.017) and presence of multiple stones (OR: 2.116, p=0.032) were found to be the independent prognostic markers of developing postoperative hydronephrosis. CONCLUSION: Ipsilateral hydronephrosis following URS develops in a significant number of patients. In patients with history of ipsilateral hydronephrosis and multiple stones, risk of development of postoperative hydronephrosis is higher, therefore physicians should be keep these parameters in mind in the decision making process of selective imaging postoperatively.
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INTRODUCTION: In this study, we aimed to investigate the effect of prestenting on success and complication rates of pediatric ureterorenoscopy (URS) procedures. PATIENTS AND METHODS: We retrospectively analyzed the data of 251 pediatric URS cases. Forty-seven of the patients were prestented. Success and complication rates of the prestented and nonprestented groups were compared and further analysis was performed with respect to stone location (renal vs ureteral) and size (7-mm cutoff). Multivariate analysis was performed to define factors associated with success rates. RESULTS: Mean age of the population was 8.9 years. Success rate of the entire population was 80.5% and significant difference between prestented and nonprestented groups was detected (91.5% vs 77.9%, p = 0.04). Higher success rates of the prestented group were also observed in ureteral stones (94.1% vs 79.5%, p = 0.04) and stones >7 mm (84.6% vs 74.1%, p = 0.72). Prestented group showed higher success rates in kidney stones, but the difference was insignificant (84.6% vs 74.1%, p = 0.72). Prestenting was also identified as an independent predictor of success in multivariate analysis. Complication rate in the prestented group was also lower, but the difference was not significant (8.5% vs 14.7%, p = 0.347). CONCLUSIONS: Prestenting was found to increase the success rate of URS in cases of larger stones and ureteral stones in pediatric population. Prestenting also provides lower, but insignificant, complication rates. However, this procedure also has significant disadvantages. Based on the results of current study, we cannot recommend routine prestenting in pediatric cases. Instead, we recommend an attempt to treat the stone in the first session and place a stent in case of failed procedure to utilize potential benefits of prestenting while avoiding disadvantages.
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Cálculos Renales/cirugía , Riñón/cirugía , Complicaciones Posoperatorias/epidemiología , Stents , Uréter/cirugía , Cálculos Ureterales/cirugía , Ureteroscopía/métodos , Niño , Preescolar , Estudios de Cohortes , Endoscopía/métodos , Femenino , Humanos , Pelvis Renal/cirugía , Masculino , Análisis Multivariante , Estudios RetrospectivosRESUMEN
OBJECTIVE: To identify the incidence and associated factors of the postoperative hydronephrosis in pediatric patients who underwent ureterorenoscopy (URS) for renal or ureteral stones. PATIENTS AND METHODS: We evaluated the results of 116 patients who underwent semirigid or flexible URS retrospectively. Primary end points of the study were to determine the incidence of postoperative hydronephrosis and factors associated with the development of postoperative hydronephrosis. Logistic regression analysis was used to define factors associated with the presence of hydronephrosis. RESULTS: Mean age of the population was 9.5 years and mean stone size was 9.4 mm. Hydronephrosis was detected in 32 (27.6%) patients. Stone-free status was achieved in 101 (87%) patients. Univariate analysis revealed history of ipsilateral URS, duration of operation, presence of impacted stone, development of ureteral injury during operation, and presentation with a renal colic episode as the parameter associated with increased risk of hydronephrosis. History of ipsilateral URS (odds ratio: 1.664, P = .027), presence of impacted stones (odds ratio: 1.788, P = .014), and development of ureteral injury during operation (odds ratio: 1.106, P = .039) were found to be the independent markers of developing postoperative hydronephrosis in a multivariate analysis. CONCLUSION: Ipsilateral hydronephrosis following URS develops in a significant portion of patients. In patients with history of ipsilateral procedure and those with an impacted stone and had ureteral injury, the risk of postoperative hydronephrosis is higher; therefore, physicians should keep these parameters in mind in the decision-making process of selective imaging postoperatively.