Association of gene polymorphisms with women urinary incontinence.

Aim of study was set to investigate the association of women urinary incontinence (UI) with serotonin receptor HTR2A T102C and beta 3-adrenergic receptor ADRB3 Trp64Arg genes polymorphisms. The study included 110 women with Urge, Stress, and Mixed UI types and the control group - 105 continent women. Both groups have filled in the ICIQ-FLUTS questionnaire and their blood genotyping was performed. Urge UI subgroup was older and had higher body mass index (BMI) in comparison to other UI types and control group. More than half of all women had family history of UI in Stress UI and Mixed UI subgroups. The frequency of HTR2A T102C gene polymorphism's minor allele C and genotype CC was significantly more expressed in Urge UI subgroup, as compared with control group (C-77.3 vs 58.7%, p = 0.007 and CC-57.6 vs 31.1%, p = 0.015). The ADRB3 Trp64Arg gene polymorphism did not differ between groups. The regression analysis revealed CC genotype (OR = 3.06, 95% CI: 1.11-8.43; p = 0.030) and allele C (OR = 2.53, 95% CI: 1.16-5.53; p = 0.020) were risk factors for development of Urge UI. We conclude that HTR2A T102C gene polymorphism affected the development of Urge UI.

Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome.

BACKGROUND: Prostatitis is the most commonly diagnosed disease in men younger than 50 years and accounts for about 8% of all urologists' consultations. OBJECTIVE: After evaluating clinical trials and demonstrating the efficacy of chronic non-bacterial prostatitis treatment, it remains of clinical importance to continue studies on the use of low-energy extracorporeal shock wave therapy (ESWT) in men. MATERIALS AND METHODS: From May 2017 to April 2018, 40 patients with chronic prostatitis (CP) type IIIB/chronic pelvic pain syndrome (CPPS) were enrolled in the study. The patients underwent ESWT once a week for 4 weeks. RESULTS: The mean age of the patients was 47.8 years. A statistically significant improvement in all the parameters, i.e., the International Prostate Symptom Score (IPSS), the visual analogue scale (VAS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and the International Index of Erectile Function (IIEF), was observed at week 4. The effect of the treatment was maintained during the entire 12-week period. The NIH-CPSI total score showed the best improvement at week 4, but a slight deterioration without a statistically significant change was noticed at week 12. The greatest improvement at week 4 was documented for the NIH-CPSI and IPSS (43% and 37%, respectively). At week 12, an improvement of 52% and 39% was recorded for VAS and IPSS, respectively. CONCLUSIONS: Our findings confirmed the effectiveness and safety of ESWT in resistant cases of CPPS in the short term. ESWT is cost-effective, which takes little time or requires a small amount of staff, and is easily conducted.

Affective Symptoms and Health-Related Quality of Life Among Women with Stress Urinary Incontinence: Cross-Sectional Study.

PURPOSE: To evaluate the relationship between affective symptoms, clinical variables of uro-gynaecological history and health-related quality of life (QoL) among women with stress urinary incontinence (SUI) in comparison to healthy controls. PATIENTS AND METHODS: In a cross-sectional study, 80 women 30 to 80 years of age diagnosed with SUI and 97 controls without symptoms of SUI provided sociodemographic data and answered the King's Health Questionnaire (KHQ) for assessing the QoL among individuals with urinary incontinence. Symptoms of anxiety and depression were assessed by Hospital Anxiety and Depression (HAD) scale with a threshold ≥7. A multiple regression was performed to reveal the cross-sectional predictors of affective symptoms and QoL among women with SUI. RESULTS: Women with SUI had a significantly higher prevalence of symptoms of anxiety and depression than the controls (50% vs 11% and 29% vs 3.1%, respectively; both p<0.001) and worse health-related QoL on all domains of the KHQ. In multiple logistic regression models adjusted for sociodemographic and clinical variables of uro-gynaecological history, perceived symptoms of mild-to-severe depression were associated with a higher amount of leakage (OR=3.59; 1.04-12.4), older age (≥55 years old vs <55 years old) (OR=5.82; 1.47-23.1) and higher BMI (OR=1.13; 1.01-1.27). In addition, when controlled for all domains of the KHQ, perceived depressive symptoms were associated with the "emotions" domain of the KHQ (OR=1.06; 1.02-1.09). Perceived anxiety symptoms (independent of age) were related to shorter duration of SUI, low parity, absence of comorbidities and to higher scores on the "personal relationships" and "emotions" domains of the KHQ. CONCLUSION: Women with SUI have a significantly poorer QoL than their counterparts without SUI. It was determined that one-half of women with SUI had anxiety symptoms, while one-third of women with SUI had depressive symptoms. In addition, this study indicated that QoL was associated with anxiety symptoms in middle-aged women and with depressive symptoms in older women, especially those with a shorter duration of SUI.

En bloc kidney transplantation from a 24 month-old donor to an adult recipient: case presentation and literature review.

Paediatric kidney transplantation into adult recipients is a well-recognised technique. However, there are different opinions regarding two methods of transplantation. These two opinions are single kidney transplantation (SKT) and en bloc kidney transplantation (EBKT) from donors up to 20 kg. We are reporting the first successful en bloc kidney transplantation from a small, paediatric donor into an adult recipient in our institution and discussing the appropriate recent literature regarding possible concerns using this technique. Despite the fact that paediatric donors are uncommon and surgical experiences are limited, en bloc kidney transplantation can be performed successfully and could be used to expand the donor pool.

Risk Factors and Types of Urinary Incontinence among Middle-Aged and Older Male and Female Primary Care Patients in Kaunas Region of Lithuania: Cross Sectional Study.

PURPOSE: The aims of the study were to evaluate the incidences, types of urinary incontinence (UI) and its risk factors among middle-aged and older (> 40 years) men and women visiting a general practitioner (GP). MATERIALS AND METHODS: This is a descriptive and cross-sectional comparative study using a questionnaire-based survey included 172 male and female patients who consecutively visited a primary care center in Kaunas region of Lithuania. RESULTS: All 86 women (100%) and 65 men (75.58%) had symptoms of UI (P < .001). About 55% of women were classified as having stress urinary incontinence (SUI) and 60% of men urge urinary incontinence (UUI) (P < .001). The risk factors for women with SUI were: age below 60 years (odds ratio [OR] = 2.89, 95% confidence interval [CI]: 1.89-4.43; P < .001), being married (OR = 6.31, 95% CI: 2.35-16.97; P < .001), sedentary-standing job (OR = 1.492, 95% CI: 1.01-2.20; P = 0.041), arterial hypertension (OR = 2.03, 95% CI: 1.39-2.96: P < .001), diabetes mellitus (OR = 3.01, 95% CI: 1.02-8.86; P = .032), menopause (OR = 1.48, 95% CI: 1.20-1.83; P < .001) and features of past pregnancies. The UUI was associated with age over 60 years (OR in men = 2.93, 95% CI: 1.15-7.51; P = .022, in women OR = 8.76, 95% CI: 2.37-32.33; P < .001. Low health-related quality of life was the most prevalent among men with UUI (50.8%) and among women with SUI (23.3%) (P = .023). CONCLUSION: UI was common among patients aged > 40 years visiting GP and affected more women of the same age range. SUI was more prevalent among women, while more men had UUI. Age below 60, being married, pregnancy and delivery history, concomitant illnesses were significant risk factors for women' SUI and older age and menopause for UUI. The only risk factor for men' UUI was age over 60 years.

TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study.

OBJECTIVES: The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). METHODS: A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients - using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). RESULTS: Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact - at 94.5% and SLING-IUFT - at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. CONCLUSION: the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.

Lippes Loop intrauterine device left in the uterus for 50 years: case report.

BACKGROUND: The first Lippes Loop intrauterine device (IUD) was introduced in 1962. It was a plastic double "S" loop, a trapezoid shaped IUD that closely fit around the contours of the uterine cavity, reducing the incidence of expulsion. This IUD was commonly used from the 1960's to the 1980's. Some authors state that the IUD can be left in the uterine cavity for an indefinite amount of time. Prolonged use of this device was common, however, it was associated with some complications like uterine bleeding during post-menopausal period and inflammatory pelvic diseases. CASE PRESENTATION: The patient was a 74-years-old woman who was admitted to a university hospital due to urinary incontinence stress. The patient's history included 2 deliveries and 20 years of menopause. During ultrasonography a normally sized and shaped uterus was found. The uterine cavity was expanded by 14 mm with some fluid. A "Lippes" loop was also seen in the uterine cavity. Both ovaries were atrophic without any abnormalities. The patient had her IUD inserted 50 years ago. Patient underwent TOT (tension obturator tape ) surgery for urinary incontinence. Evacuation of IUD and uterine curettage was also done. CONCLUSIONS: Fifty years of prolonged usage of LIPPES IUD had no influence on the woman's health during our case.

[Surgical treatment of female pelvic organ prolapse at the Clinic of Obstetrics and Gynecology, Hospital of Kaunas University of Medicine]. / Moteru dubens organu nusileidimo chirurginio gydymo metodai KMU Akuserijos ir ginekologijos klinikoje.

OBJECTIVE: To compare surgical methods, complications, and outcomes in the treatment of female pelvic organ prolapse at the Clinic of Obstetrics and Gynecology, Hospital of Kaunas University of Medicine, and to disclose the risk factors that influence female pelvic organ prolapse. MATERIAL AND METHODS: A retrospective analysis of surgeries for pelvic organ prolapse performed during the period of 2003-2007 was carried out. A total 823 women were operated on for pelvic organ prolapse. RESULTS: During 2003-2007, 823 surgical procedures for the correction of female pelvic organ prolapse were performed at the Clinic of Obstetrics and Gynecology, Hospital of Kaunas University of Medicine. Eighty (9.7%) patients underwent vaginal hysterectomy; 372 (45.3%), vaginal plastic operations (out of them, 23 were combined with TVT and 47 with TVT-O procedure); 360 (43.7%), vaginal hysterectomy with vaginal plastic surgeries; and 11 (1.3%), Prolift operations. The mean age of females was 62 years. Mean blood loss during operations was 162.1 mL. Patients undergoing vaginal plastic operations lost significantly less blood than those undergoing vaginal hysterectomy or combined operations (P<0.05). Mean time in surgery was 60.3 min. The duration of Prolift operations and vaginal plastic operations was significantly shorter than that of vaginal hysterectomy or combined procedures (vaginal hysterectomy + vaginal plastic surgery) (P<0.05). Mean hospital stay was 8.1 days. Hospital stay after vaginal plastic operations was significantly shorter than after vaginal hysterectomy or combined operations. The shortest hospital stay was after Prolift operation (P<0.05). Complications were related to the type of operation performed. CONCLUSIONS: The most common operations in the surgical treatment of female pelvic organ prolapse were vaginal plastic operations and combined operations. The shortest time in surgery and lowest blood loss was in case of vaginal plastic operations. The shortest hospital stay was after Prolift operations. The highest rate of complications was observed in patients who underwent vaginal hysterectomies, the lowest - after Prolift operations.

[Trauma in pregnancy: complications, outcomes, and treatment]. / Nesciuju trauma: komplikacijos, baigtys, gydymas.

UNLABELLED: The aim of this study was to analyze the effects of the various traumas on mother and fetus and to present the solutions of trauma management. METHODS: A review of data archive of Kaunas University of Medicine Hospital and articles published during the last 13 years (1990-2003) and selected by computerized Medline search. Trauma affects 7-8% of all pregnant women; motor vehicle accidents account for 42%, falls--for 34%, and violence--for 18% of the most frequently cited cases of injuries. Of the 27,715 pregnant females attending antenatal clinics, 372 (1.3%) experienced trauma: 84% of women had blunt injuries and 16% had penetrating injuries. There were 14 maternal deaths (3.8%) and 35 fetal deaths (9.4%). The success of pregnancy is associated with severity of maternal trauma. The survival of the fetus after trauma depends on the mother's condition in regard to respiratory passage, oxygenation, and hypovolemia. During 1990-2003, six pregnant patients with severe trauma were treated at Kaunas University of Medicine Hospital. Traumatic separation of placenta was observed in two cases. Three women and three fetuses died.