Urologic surveillance of persons with spinal cord injuries - a scoping review.

STUDY DESIGN: Scoping review - standardized according to the Equator-network and the Prisma-Statement guidelines with PRISMA-ScR. OBJECTIVES: Review the literature concerning surveillance of the urinary- and renal systems in persons with spinal cord injuries (SCI). Specifically, to assess: #1 the usability of non-invasive and non-ultrasound methods, #2 the usage of systematic ultrasound surveillance #3 patient characteristics which predispose to urinary tract abnormalities (UTA) or renal function deterioration. METHODS: The literature assessed was collected from PubMed by creating a search string comprised of three main phrases: #1 persons with SCI, #2 kidney function and #3 surveillance program. The final search resulted in 685 studies. Eligibility criteria were defined prior to the search to assess the studies systematically. RESULTS: Four studies found serum cystatin C (s-cysC) to be accurate in estimating the glomerular filtration rate in persons with SCI. One study found no difference in UTA between surveillance adherent and surveillance non-adherent persons up to 30 years post injury. UTA and especially renal function deterioration seems rare the first 15 years post-injury. Non-traumatic SCI, time since injury, high detrusor pressure, upper urinary tract dilation, vesicourethral reflux, trabeculated bladder, history of calculi removal are significant risk factors for developing UTA or renal function deterioration. CONCLUSION: Measurements of S-cysC should be considered to replace serum creatinine in most cases. Surveillance non-adherent persons are not at higher risk of developing UTA. A selective surveillance based on a baseline risk profile may be beneficial for patients and caretakers.

[Urological problems related to coloproctology. Part 1].

The aim of this review was to characterize the possible urological manifestations of rectal disorders in case of the involvement of the genitourinary system, as well as the symptoms of urological diseases involving the distal part of the large bowel. In urological and coloproctological practice, the anatomical and physiological proximity of the distal part of the intestine and the urogenital organs is of importance (for example, the common innervation of the pelvic organs, the synergy of the pelvic floor muscles, etc.), since it results in similar clinical manifestations, making it difficult to make a diagnosis. The most relevant and common urological and proctological diseases, including prostatitis, intestinovesical and rectourethral fistulas, damage to the ureter and bladder during colorectal surgery are discussed in the article. Particular attention is paid to the interdisciplinary cooperation of urologists and proctologists and the frequent need for their joint participation in the diagnosis and treatment of the pelvic organs disorders.

Overview of urological complications before, during and after kidney transplantation.

The result of a kidney transplantation may be affected by certain congenital or acquired urological diseases that need to be addressed before, during or after the kidney transplant. Complications accompanying kidney transplantation are not fundamentally different from the events that accompany other difficult surgical procedures. However, their course is usually modified by adverse circumstances in the recipient - uremia, dialysis treatment, immunosuppression. The incidence of urological complications is reported in the range of 1 to 30 % of the transplants, and they represent up to one half of all surgical complications. They can cause a significant morbidity and mortality and can lead to a delayed onset of the function and even to a loss of the transplanted kidney.Urological complications that need to be addressed before kidney transplantation include anomalies or pathological changes in the lower urinary tract, pelvic involvement in atherosclerosis or previous kidney transplants, infectious foci in lithiasis or pyonephrosis, large polycystic kidneys and malignancies. During the kidney transplantation itself, vascular complications, and complications connected with the reconstruction of the lower urinary tract can occur. Other complications are bacterial and viral infections and malignancies. All these complications require a rapid and accurate diagnosis and subsequent targeted treatment with intention to maintain a functional kidney transplant (Fig. 11, Ref. 36). Text in PDF www.elis.sk Keywords: kidney transplantation, urological, vascular, infectious, bleeding, complications.

Clinical use and complications of percutaneous cystostomy pigtail catheters in 25 cats.

OBJECTIVES: The aims of this study were to describe the indications for percutaneous pigtail catheter placement in cats requiring urine diversion, and to report the associated intra- and postoperative complications. METHODS: The medical records of cats that underwent percutaneous pigtail catheter placement for urine diversion between January 2011 and May 2021 were retrospectively reviewed. RESULTS: Twenty-five cats were included. Indications for pigtail catheter placement were medical management of obstructive urinary tract disease (n = 12), urinary tract damage after traumatic injury (n = 8) and neurological bladder dysfunction (n = 5). Catheters were in place for a median time of 8.28 days (range 3-27), and the duration of the catheter placement was not different between the medical, traumatic and neurological groups. Ten cats (40%) developed pigtail catheter complications including dislodgement, urine leakage, urinary tract infection and bladder rupture. The majority of complications were easily resolved and did not require surgical intervention. CONCLUSIONS AND RELEVANCE: The results suggest that percutaneous pigtail catheter placement can facilitate urine diversion in both the emergency setting and in the long-term management of urine retention without many complications.

[Urological complications of N.A. Nekrasovs disease].

OBJECT: to study the medical history of N.A. Nekrasov and to determine the nature of his urological disease. The work was carried out from 1977 till 2021. He studied 2616 sources related to the biography of N.A. Nekrasov and medical history. The work was carried out in the archives of Moscow, St.Petersburg, Yaroslavl, Karabikha from 1998 till 2020. The Russian poet N.A.Nekrasov had an illness, which ended in death, during 3 years, from December 1874 till December 27, 1877. He was treated by famous doctors S.P. Botkin, N.V. Sklifosovsky, E.I. Bogdanovsky, N.A. Belogolovy and an operation was performed by Theodore Bilroth. Retrospective analysis revealed the following diagnosis of N.A. Nekrasov: rectal cancer at the stage of T4NXMOP4 with invasion of the sacrum, bladder and compression of the pelvic parts of both ureters, bilateral ureterohydronephrosis with the loss of the left kidney function, chronic renal failure, purulent cystitis, partial intestinal obstruction, suppuration of the wound after colostomy performed on April 12, 1877, Acute purulent paraproctitis, paranephritis, phlegmon of the left retroperitoneal space, purulent effusion to the thigh, phlegmon of the buttock area and the left thigh, sepsis, cerebral stroke. Urological complications of the rectal cancer accelerated the lethal outcome of the poet N.A. Nekrasov who died of sepsis and uremia.

Urinary manifestations in African American and Caucasian inflammatory bowel disease patients: a retrospective cohort study.

BACKGROUND: Inflammatory bowel diseases (IBD), like ulcerative colitis (UC) and Crohn's disease (CD), are associated with urinary extra-intestinal manifestations, like urolithiasis and uncomplicated urinary tract infections (UTIs). The literature reviewed for this study identifies an increased association of CD and urolithiasis against the general population as well as UC. Furthermore, the rates in which urinary comorbidities manifest have not been well characterized in cross-race analyses. The purpose of this study is to establish the prevalence of common urinary extra-intestinal manifestations in CD and UC and to further determine at what rate these affect the African American and Caucasian populations. METHODOLOGY: This is a retrospective cohort study using de-identified data collected from a research data base that included 6 integrated facilities associated with one tertiary healthcare center from 2012 to 2019. The electronic chart records for 3104 Caucasian and African American IBD patients were reviewed for frequency of urolithiasis and uncomplicated UTI via diagnosed ICD-10 codes. Comparison between data groups was made using multivariate regressions, t-tests, and chi square tests. RESULTS: Our study included 3104 patients of which 59% were female, 38% were African American, and 43% were diagnosed with UC. Similar proportions of UC and CD diagnosed patients developed urolithiasis (6.0% vs 6.7%, p = 0.46), as well as uncomplicated UTIs (15.6% vs. 14.9%, p = 0.56). Similar proportions of African American and Caucasian patients developed urolithiasis (5.4% vs 7.0%, p = 0.09), but a higher proportion of African Americans developed uncomplicated UTIs (19.4% vs 12.6%, p ≤ 0.001). CONCLUSION: We found similar rates of urolithiasis formation in both UC and CD in this study. Furthermore, these rates were not significantly different between African American and Caucasian IBD populations. This suggests that UC patients have an elevated risk of urolithiasis formation as those patients with CD. Additionally, African Americans with IBD have a higher frequency of uncomplicated UTI as compared to their Caucasian counterparts.

Urologic morbidity associated with placenta accreta spectrum surgeries: single-center experience with a multidisciplinary team.

BACKGROUND: Hysterectomy for placenta accreta spectrum may be associated with urologic morbidity, including intentional or unintentional cystostomy, ureteral injury, and bladder fistula. Although previous retrospective studies have shown an association between placenta accreta spectrum and urologic morbidities, there is still a paucity of literature addressing these urologic complications. OBJECTIVE: We sought to report a systematic description of such morbidity and associated factors. STUDY DESIGN: This was a retrospective study of all histology-proven placenta accreta spectrum deliveries in an academic center between 2011 and 2020. Urologic morbidity was defined as the presence of at least one of the following: cystotomy, ureteral injury, or bladder fistula. Variables were reported as median (interquartile range) or number (percentage). Analyses were made using appropriate parametric and nonparametric tests. Multinomial regression analysis was performed to assess the association of adverse urologic events with the depth of placental invasion. RESULTS: In this study, 58 of 292 patients (19.9%) experienced urologic morbidity. Patients with urologic morbidity had a higher rate of placenta percreta (compared with placenta accreta and placenta increta) than those without such injuries. Preoperative ureteral stents were placed in 54 patients (93.1%) with and 146 patients (62.4%) without urologic injury (P=.003). After adjusting for confounding variables, multinomial regression analysis revealed that the odds of having adverse urologic events was 6.5 times higher in patients with placenta percreta than in patients with placenta accreta. CONCLUSION: Greater depth of invasion in placenta accreta spectrum was associated with more frequent and severe adverse urologic events. Whether stent placement confers any protective benefit requires further investigation.

Outcomes in patients of carcinoma cervix Stage IIIB treated with definitive radiotherapy.

BACKGROUND: Cervical cancer is the fourth most common cancer in women. Although cervical cancer screening is available in India, there is lack of awareness and access to screening services. Consequently, most cancers are diagnosed in advanced stagesoften with obstructive uropathy. PATIENTS AND METHODS: This was a retrospective study of stage III B (as per pre-2018 FIGO staging) cervical cancer patients who received radiotherapy at our center between 2012 and 2019. Patients with or without obstructive uropathy, age group between 18 and 85 years, were included. Definitiveradiotherapy (RT) was delivered with 3D CRT to a dose of 50 Gy in 25 fractions over 5weeks given to whole pelvis and boost of 54 Gy was given to para-aortic or retroperitoneal lymph nodes when enlarged. All patients received intracavitary brachytherapy. RESULTS: 3-year overall survival rates for patients who received only RT was 24% versus 71% for those who received chemoradiotherapy (p = 0.0001). 5-year survival for patients who received RT alone was 12% versus 63% for those who received chemoradiotherapy (p = 0.0001). 3-year PFS was 77% versus 83% and those with and without obstructive uropathy respectively. (p = 0.0001). Overall, 37(56%) patients were alive without any evidence of recurrence. CONCLUSION: Early recognition and appropriate intervention for obstructive uropathy can potentially limit the detriment to outcomes in these patients and result is good long-term cure rates in these patients.

Substances of abuse consumption among patients seeking medical help for uro-andrological purposes: a sociobehavioral survey in the real-life scenario.

Substances of abuse (SoA), as well as smoking and alcohol consumption, are well known for their impact on male fertility status, erectile function, and ejaculation. We assessed SoA consumption habits in a cohort of men seeking medical attention for uro-andrological purposes. Data from 7447 men seeking medical attention for the first time for uro-andrological purposes were analyzed. A complete medical and sexual history was collected for each patient. Smoking, alcohol, and SoA consumption were investigated. Descriptive statistics was used to describe the whole cohort. The primary motivations for their evaluation were lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and infertility in 1912 (25.7%), 2944 (39.5%), and 2591 (34.8%) men, respectively. Previous use of SoA was reported by 378 (5.1%) men, and 190 (2.6%) individuals were current users. Patients seeking medical attention for infertility were more frequently current SoA users (107; 4.1%) than men with ED (66; 2.2%) and LUTS (17; 0.9%) (both P < 0.001). Current users of SoA were younger than those with past or no SoA history (P < 0.001). Current SoA users were more frequently smokers (P < 0.001) and alcohol consumers (P < 0.001) than those with a previous history or those who had never tried SoA. In conclusion, approximately 3% of men seeking medical attention for uro-andrological purposes were current SoA consumers. Infertile men reported a higher use of SoA than those with ED or LUTS. Current SoA users were younger and more frequently concomitant smokers and alcohol consumers compared to those who did or had never used SoA.

Management of the Transitional Urology Patient: the Role of the Adult Reconstructive Urologist.

PURPOSE OF REVIEW: Patients with congenital urologic conditions present unique challenges as adults. Herein, we review the literature relevant to the adult reconstructive urologist confronted with complex surgical concerns affecting their patients with a history of hypospadias, spina bifida, and other syndromes affecting the genitourinary tract. RECENT FINDINGS: Urethral stricture disease related to hypospadias is complex, but successful urethroplasty and penile curvature correction can be achieved with an anatomically minded approach. Multiple urinary diversion techniques can be considered in a patient-centered approach to bladder management in the adult spina bifida patient, but complications are common and revision surgeries are frequently required. Strong evidence is lacking for most surgical techniques in this population, but experiences reported by pediatric and adult urologists with genitourinary reconstruction training can help foster consensus in decision-making. Urologists trained in genitourinary reconstruction may be uniquely positioned to care for the transitional urology patient as they enter adolescence and adulthood.

Results of a previously unreported extravesical ureteroneocystostomy technique without ureteral stenting in 500 consecutive kidney transplant recipients.

Urologic complications can still occur following kidney transplantation, sometimes requiring multiple radiological and/or surgical procedures to fully correct the problem. Previously proposed extravesical ureteral reimplantation techniques still carry non-negligible risks of the patient developing urologic complications. About 10 years ago, a new set of modifications to the Lich-Gregoir technique was developed at our center, with the goal of further minimizing the occurrence of urologic complications, and without the need for initial ureteral stent placement. It was believed that an improvement in the surgical technique to minimize the risk of developing urologic complications was possible without the need for stent placement at the time of transplant. In this report, we describe the advantages of this technique (i.e., mobilized bladder, longer spatulation of the ureter, inclusion of bladder mucosa with detrusor muscle layer in the ureteral anastomosis, and use of a right angle clamp in the ureteral orifice to ensure that it does not become stenosed). We also retrospectively report our experience in using this technique among 500 consecutive (prospectively followed) kidney transplant recipients transplanted at our center since 2014. During the first 12mo post-transplant, only 1.4%(7/500) of patients developed a urologic complication; additionally, only 1.0%(5/500) required surgical repair of their original ureteroneocystostomy. Five patients(1.0%) developed a urinary leak, with 3/5 having distal ureteral necrosis, and 1/5 subsequently developing a ureteral stricture. Two other patients developed ureteral stenosis, one due to stricture and one due to ureteral stones. These overall results are excellent when compared with other reports in the literature, especially those in which routine stenting was performed. In summary, we believe that the advantages in using this modified extravesical ureteroneocystostomy technique clearly help in lowering the early post-transplant risk of developing urologic complications. Importantly, these results were achieved without the need for ureteral stent placement at the time of transplant.

A Minimally Invasive Technique for the 1-Stage Treatment of Complex Pelvic Floor Diseases: Laparoscopic-Pelvic Organ Prolapse Suspension.

OBJECTIVE: The aim of this prospective study was to assess the safety and effectiveness of a new single laparoscopic operation devised to relieve obstructed defecation, gynecologic and urinary symptoms in a large series of female patients with multiorgan pelvic prolapse. METHODS: We submitted 384 female patients to laparoscopic pelvic organ prolapse suspension operation, a new technique based on suspension of the middle pelvic compartment, by using a polypropylene mesh and followed up 368 of them, with defecography performed 12 months after surgery and a standardized protocol. RESULTS: The 368 patients were followed-up for 36.3 (±4.4) months, Recurrence rate was 4.9% for obstructed defecation syndrome and 3.3% for stress urinary incontinence. Complication rate was 2.9%. The mean period of daily activity resumption was 16.3 days (±4.8 days). Anorectal and urogynecologic symptoms and scores significantly improved after the operation (P < 0.001), with no worsening of anal continence. Incidence of postoperative fecal urgency was 0%. Postoperative defecography showed a significant (P < 0.001) improvement of all parameters in 315 patients (82%). Short Form 36 Health Survey score significantly improved after the operation (P < 0.01). An excellent/good overall Satisfaction Index was reported by 78.0% of patients. CONCLUSIONS: In our experience the Laparoscopic-Pelvic Organ Prolapse Suspension seems to be safe and effective as a 1-stage treatment of associated pelvic floor diseases. Randomized studies with an appropriate control group and longer follow-up are now needed to assess the effectiveness of this promising technique.

Age-related urologic problems in the complex urologic patient.

PURPOSE: Improved medical care throughout childhood and adolescence has enabled patients with complex urological abnormalities to live longer into adulthood. These patients are now at risk of developing common, age-related, urological conditions. This review aims to review existing data and make recommendations in areas where expert opinion is currently lacking METHODS: This review represents the joint SIU-ICUD (Société Internationale d'Urologie-International Consultation on Urological Disease) consultation on congenital lifelong urology. The results of this analysis were first presented at a joint consultation of the ICUD and SIU at the 2018 SIU annual conference in Seoul, South Korea. RESULTS: BPH may present differently in patients with neurogenic bladder. Thorough assessment of neurological status, bladder and sphincter function is required before offering any bladder outlet surgery. Prostate specific antigen screening should be offered to men aged 50-69 with neurogenic bladders if they have good life expectancy. Multi-parametric MRI and transperineal biopsy would be the investigations of choice if feasible. Surgery for localized disease should only be done by surgeons with the relevant expertise. Bladder cancer in this patient group is more likely to present at a later stage and have a worse prognosis. Parenthood is achievable for most, but often requires assistance with conception. Pregnant women who have had previous urogenital reconstructive surgery should be managed in appropriate obstetric units with the involvement of a reconstructive urologist. CONCLUSIONS: Most evidence regarding complex urogenital abnormalities comes from the pediatric population. Evidence regarding common, age-related urological issues is generally from the 'normal' adult population. As patients with complex congenital urological conditions live longer, more data will become available to assess the long-term benefits of intervention.

Complications of synthetic mesh inserted for stress urinary incontinence.

OBJECTIVE: To provide an update on the literature regarding the management of complications secondary to synthetic mesh placed to treat stress urinary incontinence (SUI). METHODS: We performed a systematic review of the literature using a multi-database structured search within OVID, the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE) and Cochrane library databases; using the keywords: urology, incontinence, mesh and surgery. RESULTS: Several million synthetic polypropylene meshes have been inserted into women worldwide to manage SUI. Unfortunately, a significant number of women have now reported life-changing complications. We found a paucity of studies, heterogeneity of cohorts, poor long-term follow-up, and lack of evidence on the effective management of mesh-related complications. CONCLUSIONS: The contemporary evidence is low-level and often contradictory, which prevents robust recommendations regarding treatment. A prospective registry will be required to generate meaningful outcome data and help in the complex management of patients who have mesh-related complications.

Impact of Chronic Obstructive Pulmonary Disease on Postoperative Complications Following Simultaneous Bilateral Total Knee Arthroplasty.

For patients who qualify, simultaneous bilateral total knee arthroplasty (TKA) is a viable option for the treatment of bilateral symptoms. However, the incidence of chronic obstructive pulmonary disease (COPD) has been steadily rising over the past few decades and may impact those who qualify as candidates for bilateral TKA. As such, the aim of this study was to determine the impact of COPD on postoperative outcomes in patients who receive simultaneous bilateral TKA. A retrospective cohort study was conducted utilizing data provided through the American College of Surgeons National Surgical Quality Improvement Program. All patients who had undergone simultaneous bilateral TKA between 2007 and 2016 were identified and further stratified into groups based upon the COPD status. Incidence of adverse events after TKA in the acute postoperative period was evaluated with univariate and multivariate analyses. COPD was found to be an independent risk factor for the development of major (odds ratio [OR]: 2.5; p = 0.015), renal (OR: 5.1; p = 0.02), and thromboembolic complications (OR: 2.5; p = 0.027). In addition, patients with COPD were at increased risk for having an extended hospital length of stay (LOS; p < 0.001) and development of urinary tract infections (p < 0.001). Patients with COPD are at higher risk for development of overall major complications, as well as renal and thromboembolic complications after simultaneous bilateral TKA. Interestingly, patients were not at increased risk for the development of pulmonary or wound complications. When considering a staged versus simultaneous bilateral TKA, surgeons should be aware of the impact COPD status has on the postoperative complication rate.

Risk factors predicting upper urinary tract deterioration in children with spinal cord injury.

AIM: The aim of this study is to determine the risk factors predicting upper urinary tract (UUT) deterioration in children with spinal cord injury (SCI). METHODS: The medical records of 108 children with SCI who were referred to our unit between 1996 and 2018 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, presence of urinary tract infection, radiological evaluation of the UUT and lower urinary tract (LUT), and videourodynamic findings. The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff values of the maximum detrusor pressure during filling and the bladder volume ratio (BVR) for predicting UUT deterioration. Multivariate analyses were used to determine the risk factors predicting UUT deterioration. RESULTS: Complete data were available for 76 children. The median patient age was 15 years (2-17). The leading causes of SCI were motor vehicle accidents (44%) and fall (33%). UUT deterioration was identified in 33 patients (43%). Iatrogenic SCI etiology, abnormal radiological LUT findings, and detrusor pressures greater than 70 cmH2 O were found to be independent risk factors for UUT deterioration using regression analysis. In addition, ROC analysis revealed that a BVR less than 0.7 was the cutoff value for UUT deterioration in children with SCI. CONCLUSION: Abnormal radiological LUT findings, iatrogenic SCI etiology, detrusor pressure greater than 70 cmH2 O, and a BVR less than 0.7 were independent risk factors for UUT deterioration in children with SCI.

The effects of obesity on the human body part III: Cardiovascular, digestive, excretory, endocrine, and reproductive.

This third installment of The Effects of Obesity on the Human Body discusses the endocrine, digestive, reproductive, cardiovascular, and excretory systems. Obesity is known to upset hormonal balance, leading to widespread metabolic disorders involving organs such as the liver and pancreas. Furthermore, the hypersecretion of leptin from adipose tissue triggers various responses from the cardiovascular and gastrointestinal systems, with implications for energy and nutrient balance and uptake.

Complications of endourological procedures and their treatment.

Endourological treatment for urinary stones and other obstructive urinary tract diseases is minimally invasive but in some cases it involves serious complications. This collection of cases describes some complications of endourological procedures and how they were treated. Case 1: A case of right ultrasound-guided percutaneous nephrostomy found to be misplaced in the inferior vena cava. The case was safely managed, but it showed that ultrasound guidance alone may be insufficient so it is recommended that percutaneous nephrostomy should be always placed under fluoroscopic control, either alone or in combination with ultrasound guidance. Case 2: A case of renal subcapsular hematoma occurring on retrograde intrarenal surgery at high perfusion pressure. The hematoma was drained under combined ultrasonic and radiological guidance. Post treatment recovery was uneventful. Large stone size, severe ipsilateral hydronephrosis, long operation time, higher hydrostatic pressure of the irrigating solution and low ureteral wall compliance are supposed to be risks factors associated with renal subcapsular formation. Management strategy should be tailored to patient's clinical conditions. In hemodynamically stable patients, large hematoma drainage is recommended to prevent further complications and favours early recovery. Case 3: A case of double J stent fracture discovered one month after the insertion to relieve obstruction from a 1 cm stone in the right proximal ureter. The distal fragment of the stent was removed by cystoscopy while the proximal fragment was removed by semirigid ureteroscopy in two sessions due to fever and extensive calcification. Case 4: A mini-invasive technique for transurethral replacement of completely encrusted urinary stents in female patients. This technique allows the interventional radiologist to replace obstructed urinary stents by avoiding more invasive and traumatic urological procedures with sedation.